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7/29/2019 One Lines Spring Exam 2
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Buzz word definition
Volume overload Series hypertophy
Presure overload Parallel hypertrophy
Labl excrescences as you age you develop filliform processes on mitral andaortic valve, probably from small thrombi
Brown atrophy Lipofuscin deposits in a small heart
Signs of aging More picardial fat, lambl e, lipofushin deposits, basophilicdegneration
Cardiovascular dysfunction Most common failure of the pump, obstruction to flow isatherscleoris, regurgitant flow is murmurs, shunter flow,
disorder of cardiac conduction, rupture of the heart or majorvessesl
Frank starling mechanism Increased filling volume dilates the heart and enhancescontractility
Contraction dysfunction Systolic dysfunction
Filling dysfunction Diastolic dysfunction
Pressure overloadhypertrophy
Concentric hypertrophy
Volume overload Ventricular hypertrophy
L heart failure Back up of blood in the lungs, poor peripheral perfusion,pulmonary edema, Kerley B lines, heart failure cells(hemosiderin laden macrophages), orthopnea, dyspnea,prerenal azotemia
Chf Always characterized by decreased CO and tissueperfusion
Most common cause of Rheart failure
Left heart failure
R heart failure Congestive hepatomegaly, centrilobular necrosis, cardiacsclerosis, cardiac cirrhosis, congestive splenomegaly,nutmeg livers, ascites, edema of the periphery
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Buzz word definition
75% blockage Stable angina
90% blockage Unstable angina
Apex, anterior wall of left
ventricle and ventricularseptum
LAD
Posterior of septum, base Right coronary or left circumflex
Lateral Circumflex
Dominant cause of IHD Insufficient coronary perfusion relative to demand
Prinzmetal angina Vasospasm
Unstable, crescendo angina Precipitated by progressively lower levels of physicalactivity preinfarction angina
MI Women more likely after menopause estrogen hascardioprotective effect
Most common MI Thrombosed coronary artery
Problems with MI Past 20-30 minutes you get cell death
4-12 hours Early coag necrosis
1-3 days Yellow tan infarct
10-14 days Collagen deposition
2 months Dense collagenous scar
Most MI Transmural
STEMI Transmural ST elevation
NSTEMI Subendocardial, non ST elevation
Triphenyltetrazolium chloridestain
MI shows up as pale zone, everything else is brick raid
Extension Infarcts may expand beyond their borders following the MI,repurfusion injury
Myocytolysis At periphery of infarct, vaculoar degeneration
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Buzz word definition
Contraction bands Eosinophilic intracellular stripes, layer of perfused vs deadtissue
Troponin Rises 2-4 hours, peaks at 48, stays elevated 7-10
CK-MB Rises within 2-4 hours, peaks at 24, stays elevated 72hours
Ruptures More common in free wall than septum, 3-7 days
Dressler syndrome Fibrinous pericarditis, following transmural MI
Mural thrombus Thrombus originates in the heart chamber
Chronic IHD Usually enlarged and heavy due to LV hypertrophy hearts
Sudden cardiac death Most common cause arrhythmia, Long QT or WPW
Systemic Left sidedhypertensive heart disease
Initially left ventricular hypertrophy then later itshypertension,
Pulmonary right sidedhypertensive heart disease(cor polmonale)
Most commonly after pulmonary embolism for acute,chronic results from R ventricular hypertrophy secondary tolung diseases
of all valve disease Stenosis of aortic and mitral valves
Mitral valve stenosis Rheumatic heart disease
Mitral insufficiency Mitral valve prolapse (myxomatuous degeneration)
Most common valve disease Calcific aortic stenosis, age related- wear and tear
Calcific aortic stenosis Heaped-up calcific masses within aortic cusps thatultimately protrude through the outflow into valsalva
Mitral valve prolapse Mid systolic click, key histologic change, myxomatousdegeneration, most common surgical repair or replacementof mitral valve
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Buzz word definition
Rheumatic fever Aschoff bodies, caterpillar cells, pancarditis, verrucae,MacCallum plaques, leaflet thickening, commissural fusionand shortening, and thickening and fusion of the tendinous
cords, MITRAL VALVE, STREP A, Jones criteria: migratorypolyarthritis, pancarditis, subcutaneous nodules, erythemamargination of the skin, sydenham chorea (neruo disorderwith rapid involuntary movements)
Infective endocarditis Hallmark is vegitations. Most common on previouslydamaged valves by strep viridans, S auerus most virulentIV drug users, prosthetic valve- epidermidis. Ringabcesses, emboli may be shed from vegitations leads toseptic infarcts, subacute endocarditis is less valvulardestruction, develop new fever and murmur is IE. Janeway
lesions nontender palms or soles, ossler nodes in pulp ofdigits, retinal hemorrhages roth spots
Liebman-sacks endocarditis Noninfected/ sterile vegitations in debilitated patientsassociated with systemic lupus
Carcinoid heart disease Episodic flushing of the skin, nausea, vomiting,TRICUSPID
Complications of artificialvalves
Thromboembolic complications, infective endocarditis,WARFARIN for life
Dialated cardiomyopathy Less than 40% EFImpaired contractilitySystolic dysfuncionAlcohol, preggos, sarcoiosisMural thrombiNaxos syndrome- disorder characterized by arrhymogenicRV cariomyopathy and hyperkeratosis of planar skinsurfaces that is associated with mutations in the geneencoding plakoglobin
Hypertrophic cardiomyopathy 50-80% EF
Impairment of complianceDiastolic dysfunctionHyptertensive heart disease , aortic stenosisBananna like configuration- bulgin of the ventricular septuminto the lumenMyofiber disarrayHarsh systolic ejection murmur
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Buzz word definition
Restrictive cardiomyopathy Decrease in compliance, resuling in impaired ventricularfilling during diastoleAmyloidosis
45-90% EF
Meckels diverticulum Rule of 2s failed involution of vitelline duct
Most common intestinaldevelopmental
Imperforate anus
Pyloric stenosis Congenital more common males, 2nd-3rd week of life andnew onset regurg nonbillious vomitting
Hirshbrung disease Congenital agonglionic megacolon, deficient migration ofneural crest cells, lacks both gut plexuses, RET mutations,
rectum always affected usually limited to rectum andsigmoid colon
Gastrochisis Membranous sac present
Zenker diverticulum Upper upper esophageal sphincter
Traction diverticulum Middle of esophagus
Epiphrenic diverticulum Lower of esophagus
Esophageal stenosis Most common from scarring from GERD
Esophageal webs Associated with GERD, normally upper esophagus anddysphagia
Plummer-Vinson akaPatterson Brown Kelly
Webs, glossitis, iron deficient anemia
Esophageal rings askaSchatzki rings
Similar to webs but circumferential and thicker
A rings Present at the distal esophagus
GERD Sqaumous to noncilliated columnar with goblet cells
Achalasia Increased tone of lower esophagus sphincter: incompleteLES relaxation, increased LES tone, and aperistalsis,primary=neurons, secondary= chagas
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Buzz word definition
Esophagitis Mallory-weiss= longitudinal lacerations with vomiting,Boorhave syndrome= distal esophageal rupture(catastrophic)
Candiadasis white grey pseudomembranes
GERD Hyperemia, more eosinophils, and basal zone hyperplasia.In preggos, obese, alcohol, hiatal hernia
Eosinophilic esophagitis High numbers of intraepithelial eosinophils, failure of highdose PPI and absence of acid reflux
Barret Esophagus Increased risk of andenocarcinoma, epithelial dysplasia isconsidered to be a pre-invasion lesion, presence of Gobletcells
Esophageal varices Rupture is a medical emergency, pt will have portalhypertension and cirrhosis
Adenocarcinoma Typically GERD, lower of esophagus, H pyloriassosciated with decreased risk of adenocarcinoma
Sqaumous cell carcinoma More in african americans, middle of esophagus, fromalcohol and tobacco; top is cervical, middle is mediastinalor partracheal, lower is gastric and celiac nodes
Acute gastritis NSAID, H pylori, surface epithelia is intact, presence ofneutrophils and active inflammation, erosion denotes theloss of the superficial epithelium, concurrent erosion andhemorrhage is termed acute erosive hemorrhagic gastritis
Acute gastric ulceration Round small, found anywhere
Most common cause ofchronic gastritis
Infection with H pylori
H pylori Associated with over crowding, predominantly antralgastritis, high acid production, virulence: flagella, urease,
adhesins, toxins. Multifocal atrophic glossitis, intraepithelialneutrophils and subepithelial plasma cells, lymphaggregates: MALT
Curling ulcer Severe burns
Stress Shock
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Buzz word definition
Cushing ulcer Increased intracranial pressure
Autoimmune gastritis Antibodies to parietal cells and intrinsic factor, usually in the
body, invasion of lymphocytes and macrophages,decreased acid production (achloyhydria), increasedgastrin, neuroendocrine hyperplasia
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Buzz word definition
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Buzz word definition
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Buzz word definition
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BIOCHEMISTRY!!
BUZZ WORD DEFINITION
RLS of TCA Isocitrate to alpha ketoglutarate, isocitrate dehydrogenas
Energy generation in TCA NADH after isocitrate, alphaketoglutarate, and succinateGTP after Succinyl CoA, and FADH2 after succinate
Increases rate of TCA cycle ADP and calcium on RLS and increase calcium on alphaketoglutarate dehydrogenase
NADH inhibits Isocitrate dehydrogenase, alphaketoglutarate and malatedegydrogenas
Hydrolysis of thioester bond From acteyl coA, drives reaction forward
Alphaketoglutaratedehydrogenase Huge enzyme complex made up of 4 parts:E1: aplhaketoacid decarboxylase contains TPPE2: transcyclase containing lipoate, transfers acyl portionE3: dihydrolipoyl dehydrogenase, contains FAD
Decreased TPP From thiamine, leads to heart failure because alphakeotdyh. Doesnt work and heart relies on a lot of energy fromNADH
Sources of acetyl coA Beta-oxidation of fatty acids, from pyruvate via PDC, andseveral AA
1st step of ETC NADH CoQ oxidoreductase
2nd step of ETC Succinate dehydrogenase
3rd Step of ETC CoQ
4th Step of ETC Cytochromes Bc1 to oxidase
Oxidate phosphorylation Never reversible
Energy yield 2 ATP per NADH, 1.5 ATP for FADH2, major source of heat
MERRF Myoclonic epileptic ragged red fiber diease, mitochondriahave too many cristae, DNA mutations in Lysine tRNA
ATP synthesis regulated by Amount of ADP present
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BUZZ WORD DEFINITION
UPC1 (thermogenin) Brown fat, activated by FA, transports protons from cytosolicside of inner mitochondrial membrane to back intomitochondrial matrix without ATP generation, it uncouples
oxphos which generates heat
Initiation of apoptosis Release of cytochrome C and other proteins into the cytosol
Initial phosphorylation ofglucose
Commitsit to metabolism in the cell
F6P to F6BP Is first committed step in glycolysis
G6P Inhibits hexokinase
PFK1 Rate limiting step, inhibited by ATP and citrate, stimulated by
AMP and F26BP
Pyruvate dehydrogenase Shuttles pyruvate to acetyl coA, inhibited by NADH andAcetyl coA, stimulated by ADP and Ca2+
Pyruvate kinase Pyruvate to lactate, inhibited by ATP, stimulated by F16BP
G3P shuttle Inner mitochondrial membrane is impermeable to NADH,you need a way to get the energy out, works throughDHAP--> G3p which generates FADH2 for ETC
Malate-aspartate shuttle Oxaloacetate cannot cross mitochondrial membrane so it
becomes aspartate which can. It is a cytosolic reducingequivalent both sides make NADH
Increased HIF Increases PFK1c
Cori cycle Shuttles lactate and glucose between the liver andperipheral tissues
Increased NADH Prevents pyruvate oxidation in TCA cycle and directspyruvate to lactate
MEOS Metabolizes ethanol through CYP2E1 P450
Breakdown of ethanol Ethanol-->acetaldehyde-->acetate-->acetyl CoA-->TCAcycle
Homozygous ALDH2*2 Absolute protection against alcoholism, alcoholics aretreated with acetaldehyde dehydrogenase inhibitors
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BUZZ WORD DEFINITION
ADH1B*2 Very fast ADH, associated with decreased alcoholismbecause of negative side effects associated withacetaldehyde accumulations
Highest activity for ethanol CYP2E1, chronic consumption of alcohol increases theselevels and the ER undergoes proliferation
Drinking a little bit,metabolized by...
ADH 1 and ALDH 2
Drinking a lot, metabolizedby
MEOS
Metabolism through ADH Yields more energy!
AST/ALT>1 Acute viral hepatitis
AST/ALT
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BUZZ WORD DEFINITION
Dilichol phosphate Transfers branched sugar chains to amide of nitrogen ofasparagine residues
I Cell Disease Lysosomal enzymes lack mannose 6P marker that targetsthem to lysosomes
Sphingolipids Produced in the golgi
Hexosaminidase A Tests for tay sachs, they will have a decreased amountpresent, accumulate GM2 but nitgloboside
Sandhoff disease Both A and B hexosaminidase are deficient same symptomsas tay sachs with an accelerated time table
apoB48 Intestine
apoB100 Liver
LPL on capillary walls Responds to APO CII on chylomicron to digest TG to FA andglycerol
Remnants Take up through recognition of ApoE
Orlistat Drug that blocks action of pancreatic lipase
MTP inhibitors MPT facilitates making larger B particles by adding lipidsand TG, without this you have abetalipoproteinemia, right
now they have too many bad side effects
ABCA1 Reverse cholesterol transport and biogenisis of HDL, movescholesterol from inner to outer leaflet so that HDL canaccept it, while LCAT helps the HDL trap the cholesterol
RLS of Cholesterolmetabolism
HMG CoA to mevalonate
Regulation of HMGCoA 1. Free cholesterol binds to Scap which inhibits SREBP frombinding to DNA to stimulate transcription of DNA forHMGCoA reductase gene
2. Cholesterol and bile salts increase proteolysis anddegredation of HMGCoA reductase
3. HMGCoA reductase regulated through phosphorylation
ACAT Cholesterol ester production in the liver
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BUZZ WORD DEFINITION
Bile Salt RLS 7 alphahydroxylase, enzyme activity decreased by anincrease in bile salts
Familial HDL deficiency andTangiers disease No ABCA1 so HDL is rapidly degraded
Primary clearance ofcholesterol esters
Scavenger receptor steals esters from HDL then releasesHDL to collect more
LDL receptors reconize ApoB100 or ApoE
Scavenger receptors Not subject to down regulation so they will take up andoxidize more cholesterol developing foam cells
CAH mutation Mutation in 21alphahydroxylase so no aldosterone or
cortisol formation
RLS for Steroid Synthesis CYPIIA: Cholesterol to pregnenalone
Aromatase Formation of estradiol estrone
Vitamin D synthesis 1alphahydroxylase conversion to calcitriol in the kidney
Metformin Decreases blood glucose by inhibiting hepaticgluconeogenesis by activating AMPK through