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Endogenous Antioxidants
- Super Oxide Dismutase
- Catalase
- Glutathione
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Exogenous Antioxidant
Vitamin E (lipophilic)
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Which cells are particularly susceptible to damage from radiation?
- GI tract
- Bone Marrow
- Lymph Nodes
- ovarian follicles
- a fetus!
- Cancer cells
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Atrophy
decrease in cell SIZE (starving)
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Hypertrophy
Increase in cell SIZE (feasting)
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Permanently non-dividing cells (stay in G0)
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Causes of hypoxemia.
- improper ventilation
- improper diffusion of oxygen from the alveolus to the blood
- improper BF through lungs
- Anemia
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Causes of hypoxia.
- anything that causes hypoxemia
- decreased oxygen carrying content
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What is ischemia and an example?
- insufficient blood supply to a tissue or organ
- constricted BV
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What is infarction?
ischemia with necrosis
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What is responsible for secondary active transport?
sodium
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Four common themes in cell injury
- ATP depletion
- free radicals & ROS
- Lots of increased intracellular Ca++
- Defects in plasma membrane
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Where does lactate come from? What is it?
- anaerobic respiration (2 pyruvates are converted to lactate)
- It acts as a buffer
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What two main things happen with decreased ATP production that leads to membrane damage?
- Decreased fxn of Na+ pump, so there is an increase in intracellular Na+ (causing increase in water and then swelling) and Ca++ and increase in extracellular K+
- ER dilation - ribosomes detach, protein synthesis decreases, and lipids are deposited
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What two things cause IRREVERSIBLE cell injury?
- Membrane damage
- Release of lysosomal enzymes
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Normal osmolality
280-294 mOsm/kg
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Difference b/w osmolarity and osmolality.
- Osmolarity is the concentration of molecules per WEIGHT (kg) of water
- Osmolality is the concentration of molecules per VOLUME (Liter) of solution
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What is tonicity?
The effective osmolality of a solution
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A nernst potential will develop across a membrane if what two criteria are met?
- 1. if a concentration gradient exists across the membrane for a given ion
- 2. If selective permeation pathways (i.e. selective ion channels) exist that allow that transmembrane movement of the ion of interest.
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What can hypoparathyroidism cause?
tetany (because of low Ca++)
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Five types of necrosis and where they are.
- Coagulative (everywhere but the brain)
- Liquefactive (brain)
- Gangrenous
- Caseous (TB)
- Fat (pancreas)
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Difference b/w ADH and aldosterone secretion?
- ADH: retains water
- Aldosterone: retains Na+
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Dominant or recessive? Familial Hypercholesterolemia
Dominant
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Dominant or recessive? Sickle Cell Anemia
Recessive
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Five nondisjunctions and their associated chromosomes
- Down Syndrome (21)
- Edward (18)
- Patau (13)
- Turner (45:X)
- Klinefelter (47:XXY)
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Dominant or recessive? Cystic Fibrosis
recessive
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Dominant or recessive? Lysosomal Storage Diseases (Tay-sachs, Gaucher, Niemann-Pick)
Recessive
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Dominant or recessive? Glycogen Storage Diseases
Recessive
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Dominant or recessive? PKU
Recessive
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Dominant or recessive? Huntington disease
dominant
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Dominant or recessive? Achondroplasia
dominant
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Dominant or Recessive? Retinoblastoma
dominant
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Dominant or recessive? Marfan Syndrome
dominant
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Dominant or recessive? Li-Fraumeni
dominant
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How can thrombophlebitis or hepatic obstruction lead to edema?
This is a venous obstruction, causing increased hydrostatic pressure within capillaries, forcing fluid OUT.
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How can liver disease or protein
malnutrition cause edema?
They cause decreased plasma protein production, which decreases capillary oncotic pressure
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How can glomerular disease of the kidney
(nephrotic syndrome) or serous drainage from open wounds cause edema?
They cause loss of capillary plasma protein = decreased oncotic pressure
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How can hemorrhage, or cirrhosis of the liver cause edema?
They cause loss of capillary plasma protein = decreased oncotic pressure
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How do burns cause edema?
- They cause loss of capillary plasma protein = decreased oncotic pressure
- Protein escapes from the plasma, causing an increase in capillary membrane permeability
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How do crushing injuries, neoplastic disease, & allergic reactions cause edema?
Protein escapes from the plasma, causing an increase in capillary membrane permeability
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How does a lymph obstruction contribute to edema?
- It usually absorbs interstitial fluid and the small amount of proteins that pass across the capillary membrane.
- When the lymphatic channels are blocked or surgically removed, proteins and fluid
- accumulate in the interstitial space causing lymphedema.
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Two things that cause increased hydrostatic pressure, leading to edema.
- venous obstruction or
- salt and water retention.
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How can edema cause dehydration?
large amount of fluid is lost to interstitial space, reducing plasma volume and causing shock (ex = burns)
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How does ANP work?
- targets kidneys and causes decrease in Na+ reabsorption & increase in Na+ excretion
- water follows, decreasing BV & BP
- Also causes vasodilation
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What could be a cause of insuffecient oncotic pressure leading to edema?
- liver failure = decreased production of plasma proteins
- kidney damage = proteinuria
- malnutrition
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Increased capillary hydrostatic pressure is usually secondary to what?
- HR
- (venous pressure increases, so net drainage decreases)
- (fluid is retained at higher rate than can be drained by lymph)
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Some causes of hypernatremia.
- inappropriate admin of hypertonic soln (ie. NaHCO3 during cardiac arrest)
- oversecretion of aldosterone (primary hyperaldosteronism)
- Cushing syndrome (excess secretion of ACTH, which causes an increase in aldosterone secretion)
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Some causes of hyponatremia.
- fever or respiratory infection
- DI (deficiency in ADH)
- DM
- Polyuria, profuse sweating, diarrhea
- *vomiting, diarrhea, GI suctioning, burns
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Usual causes of hyperchloremia.
- excess Na+
- HCO3- deficit (metabolic acidosis)
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Tx for hyperchloremia.
depends on the cause (i.e. ingestion of ammonium chloride diuretic)
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S/S of hyperchloremia
no specific s/s
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Usual causes of hypochloremia.
- hyponatremia or
- elevated HCO3-
- (metabolic alkalosis)
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What happens to K and H in acidosis?
- H moves from ECF to ICF b/c K shifts out of the cell to maintain balance of
- cations
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What happens to K+ in alkalosis?
causes K+ to shift into the cell which causes hypokalemia
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3 hormones that promote K+ movement from ECF to ICF.
- aldosterone
- insulin
- epinephrine
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Acidosis causes ____kalemia.
- Hyper
- (H+ moves into cells, K+ moves out)
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Alkalosis causes ____kalemia
hypo
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How do anti-hypertensives cause K+ loss?
- they cause Na+ loss, and
- the kidney tries to recover Na+ in exchange for K+ = hypokalemia
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If you see hypochloremia, what is most likely the problem?
hyponatremia
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An increase in anion gap means ____ acid
increased
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Most common cause of hypokalemia.
(respiratory) alkalosis
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Free Ca++ is affected by what?
amount of protein in body (lots is bound to plasma proteins)
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An increase in phosphate usually means what?
RF
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Uric acid is usually the result of what?
DNA/cell breakdown (it's a waste product)
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Two conditions where a pt would have incresaed uric acid levels.
- Gout
- Leukemia
- (decreased ability to get rid of it)
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What does increased direct bilirubin mean?
- the liver is conjugating it but can't get rid of it, so increased conjugated bilirubin
- possible prob w/ biliary system
- possible GI problem
- (light feces, dark urine)
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What does an increase in total or unconjugated bilirubin mean?
- bilirubin is being made but there is a problem conjugating it (hepatocytes)
- can be due to increased bilirubin production secondary to hemolytic disease
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What type of lab results would you see with a liver problem r/t bilirubin?
- increased AST/ALT
- increased total bilirubin
- normal direct bilirubin
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Where is albumin made?
liver
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What does it mean if you have decreased albumin & decreased total protein?
- losing albumin in kidney, or
- liver failure (not making it fast enough)
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What does it mean if you have decreased albumin & NORMAL total protein?
- another protein is being made at an increased rate and
- the liver is only making enough albumin as it need to make
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How does the measure of RBCs and H&H relate to anemia?
- RBCs does not
- anemia = decreased Hgb & Hct
- Hgb is a measure of protein content in bld
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If H&H are significantly increased, what does this mean?
- it is difficult for the heart to pump blood
- more RBCs than plasma (very thick) cardiomyopathy (heart working too hard)
- pathological hypertrophy
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What is MCV?
- Mean corpuscle volume
- size of RBCs
- (ex: pernicious anemia)
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________ increase in most bacterial infections;
_____ increase in some viral infections.
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What would be the indication if a pt was anemic but there was no increase in reticulocytes?
- normally there will be an increase
- if not, there is a problem with the BM b/c that is where they are made
- could be a problem with the signal (EPO) to make more RBCs
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If plt ct is less than 140,000, what does that mean?
clotting too slow
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What does a INR of < 1.0 mean?
pt is clotting faster than normal
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What does a INR of > 1.0 mean?
pt is clotting slower than normal
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INR is the result of ________ testing.
prothrombin
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Main fxn of DNA
blueprint for ribosomes to make proteins
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mRNA is used to make _____
protein
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a series of _______ is translated into a series of _____ to make a protein.
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What is DNA methylation and its significance?
- can inhibit transcription
- can silence a tumor-suppressor gene & increase risk of cancer
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