Pass Program Notes 2

resexuwe's version from 2017-08-10 13:36

Protein Structure

Question Answer
What keeps amino acid together?Peptide bond -> Flat, restricted mobility, R groups facing eachother(Transconfiguration)
Acid HydrolysisDenatures protein Can NOT sequence & destroys aspargine and glutamic acid
What two amino acids turns acid when dipped in acidic environment?Glutamine ->Glutamic acid / Aspargine-> Aspartic acid
Clinical Correlation AcidosisDenature protein, Serum K rises(Arrythemias), Kussmaul breathing -> GABA
Clinical Correlation Alcohol or coca cola or any acidDenature protein, dilated cardio myopathy-> You mess up every protein in your body
Aspargine & Glutamine are neutral so they go to theliver -> If the become charged in an acidic environment -> will end up in kidney(failure), does not go to liver (failure)
Gel electrophoresisLarge protein dragging through vasoline eg-Multiple Myeloma / Does NOT sequence protein
Ninhydrin reactionGood only for counting prolines Hair or blood vessels or GI tract would be very Ninhydrin reaction
PITC or Edmans degradationReacts with an amino acid starting on the amino terminal
Restriction PeptidasesRestricted by what amino acids they can recognize Sequences protein
TrypisnCuts right to LYS & ARG
ChymotrypsinCuts to the right of armoatic acids PHE,TRP,TYR(bulky amino acids)
ElastaseCuts to the right of GLY, ALA, SER, the 3 smallest amino acids
CNBrCuts to the right of MET
AminopeptidaseCuts to the right of amino terminal amino acid
Carboxypeptidasecuts to the left of any amino acid on the carboxyterminal -> Only one that cuts to the left!!!!!
Mercapto-ethanolBreaks up disulfide bonds Cysteine -> PIGI hormones Prolactin, Insulin, Growth Hormone, Inhibin (all are big in cysteine)
Clinical Correlation -If you are alcoholic you break down disulfide bonds causingCant lactate, Diabetic, Stop growing
Alpha Helix amino acidsProline Twists & turns
Beta pleated sheetsSkin, blat bones(sternum, scapula, ribs)
Serum proteinsFunctionalAlbumin, Ceruloplasmin,transferrin,thyroglobulin / Acute phase reactants Inflammation
Clinical Correlation ESR or CRPToo many proteins -> Inflammation -> Eg. Adipose tissue -> IL-6(macrophages or T-helper cells -> Inflammation -> Increase ESR -> Arteritis -> Cardiovascular risk
ESR how to make senseHigh ESR will help us know that it is due to an inflammatory condition & also follow the treatment prognosis
AmylodosisDue to too much protein -> Increased water concentration -> Dilated EVERYTHING
Primary AmyloidosisAutosomal dominant -> Young & dies due to massive intracerebral hemorrhage -> Blood pressure rises quickly and the vessels are not compliant so bursts Apple green birefringence, Congo red, enlarged organs
Secondary AmyloidosisDue to chronic inflammatory disease
Secondary Amyloidosis typesAASLE / AB(BETA or Tau protein) Betalipoprotein E4Alzhemiers disease / AB-2(Beta 2 microglobulin) Renal failure / AE or AF(Endocrine or Familial)MENS / ThyetrinAGING
Lipofuscin is a oxidizedLipid NOT protein
Primary structureAmino acid sequence
Tertiary structure keyHydrophobic or hydrophilic interactions or covalent bonds
Clinical Correlation AlcoholicMuscle breaks down -> Denature protein -> Dilated cardiomyopathy, Vasodilation(hypotension) -> Hyperkalemiaarrythemia -> Kussmaul breathingbreathing hard behind her -> GABA brain slows down (blackouts)
1st time drinker vs Life time drinkerTolerance-> 1st time drinker has less enzymes than life long drinker
Second windPo2 drops below 40 -> myoglobin or HbF will desaturate -> give you a whole bunch of oxygenation -> Muscle denature
p02 at 60 means90% Saturation -> Oxygen delievery to 3 most important organs -> tell nurse to keep the oxygen saturation above 90%
Clinical Correlation High altitude training or Mask training or blood flow restriction HYPOXIC1 Polycythemia(more RBC's), 2 Increased mitochondrial density(makes more ATP), 3 Increased angiogenin(more blood vessels more oxygen)
Clinical Correlation Blood dopingLook for high Hematocrit with low or normal erythropoeitin
Clinical Correlation ClubbingNew blood vessels are very leaky -> as they leak out this will cause swelling of finger tips
CPK IncreasedMyositis
Myoglobin increasedRhabdomylosis
MyoglobinFound in muscle, weak acid and toxic to the kidney Crush injury -> tx fluids + Sodium Bicarbonate
Polycythemia of the newbornsBaby born with erythropiesis liver, spleen, flatbones, long bones -> Hypoxia during birth -> Increased RBC after birth -> Splenomegaly -> 2days into birth Jaundice
Syntheize -> AnabolicCytoplasm
Break something down -> CatabolicMitochondria except Glycolysis
5 pathways occur in both cytoplasm and mitochondriaHUG-FPyrimidine Heme synthesis / Urea cycle / Gluconeogensis / Fatty acid synthesis / Pyrimidine Synthesis
Clinical Correlation take iron withOrange juice due to Vitamin C antioxidant in GI sx- GI upset after ingestion without juice
4porphyrin rings+ Iron(Fe2)Heme
Fe3Methemoglobinemia -> Normal pO2 but Low oxygen saturation oxygen is there in blood but cant pick it up
Sodium Nitroprusside sxCauses cyanide poisioning -> Normal pO2, Low oxygen saturation
Transfernin responsible for absorbing Iron foundIn duodenum
90% if ferritin found inMucosal cells -> gi bleed leads to dficiency
Microcytic Hypchromic AnemiaSmall low hemoglobin anemia
Clinical Correlation Iron found inFresh meat not patties
HepicidinAcute phase reactant in chronic disease
How to differentiate Iron def VS Chronic diseaseFerritin -> Serum iron low BUT FerrItin normal or high & TIBC low in Chronic disease
SLENever reversible, Renal Involvement, Anti-cardiolipin,smith,dsDNA
Drug induced lupusReversible, No renal involvement, Anti-Histone
1st degree burnSunburn / Epidermis only / Red skin / No tx
2nd degree burnEpidermis & beneath epidermis / Swelling & blisters / Must give fluid resustiation
3rd degree burnEpidermis, Beneath epidermis, Dermis / Sx Neuropathy / Tx Fluid resustiation
Sickle cell pt starts presenting from age 6 with dactylitisSwitches from HbF to HbA hemoglobin
A-thallasemia Major 4 genesHydrops fetalisheart failure
A-thallasemia Minor 1 gene missingAsymptomatic
B-thallasemia Minor 1 gene missingAsymptomatic Ineffective erythropoiesis increased RBC mass but has anemia
B-thllasemia Major 4 genes missingAsymptopatic till 6 months -> Transfusion dependent
Blue Bloater VS pink PufffersChronic BronchitisCyanosis VS EmphysemaNo cyanosis
Terminal bronchioles haveLeast resistance even though theyre smaller but are in parallel
Round nodular opacities, Rheumatoid arthritisSilicosis
Aerospace, nuclear weapons, non caseating granulomas, round lesions without egg shell calcificationBeryiliossis
Increased b-hcg & LDH in a turner ptDysgerminoma
Muscle breakdown in McArdle disease lead toRhabdomyolysis-> Complication Renal damage
Drainage from umbilicus without stool or pusPatent Urachus -> ~Failure of Allantosis regression
SCABSkin, Connective Tissue, Arteries, Bonemarrow
Any fluid of the body falls underConnective tissue-> Type II collagen
Red ragged or wavy red fibersMuscle falling apart
I cell diseasemannose 6 phosphate deficiency meaning no enzymes will end up in Lysosomes Acid hydrolases in the plasma
DesmoplasiaBening tumor
Type I collagen symptomsDry thin skin, petechiae, purpura, ecchymoses, increased BT
Type II collagen symptomsArthritis, fractures, osteomyelitis, fascitis,
Type III collagen symptomsVasculitis, inflammedvessels, clots, bleeding, nephritic syndrome
Type IV collage symtposmLens, retina, aorta, glomerulus
Stretchy velvty skinEhlers Danlos
Long wing span, arachandactly(digging nose),MVP, RG, Retinal detatchment looking up to mars, abnormal growth of there duraMarFan
Child with vascular disease, looking down retinal detachment, Homocysteine methyl trasnferase deficiency-> High urine methionineHomocystinuria
Bleeding from follicles or gumHomocystinuria
Blue sclera, multiple fractures(canthold, feed, touch,piece of bone around the fracture on xray)Osteogensesis imperfecta
Orange hairinky kinky hair
PleiotropySimple mutation with other physical defects
3 marfanoid diseaseHomocystinuria, Marfan, MEN IIB
Post infections arthritisReiters
Bamboo spine, lose of height, middleage male, sacroiliac & lumbar joint , aortic arch dissectionAnjylosying spondylitis
Silver oval plaques on extensor surface, tramatize skin another plaque shows up, do pick at the plaque-> Bleeds, Pittin of nails or holes, sausage digits, Gout-> kidney stones-> High turnover -> folate deficiencyPsorasis HLA B13
Psoraritic ArthritisHLA b27
Two disease that affect DIPOsteoarthritis & Psoriartic arthritis
Attacks only aorta vaso vasorum(blood vessels & wall of aorta), tree bark or obliterative appearanceSyphilis
Asian female with weak pules, granulomas(t cells& macrophages) chewing away the aorta, c-reactive peptideTakayasu Aorta
Anti smooth muscle(skin, GI, blood vessels), most onion skinning in the kidneyScleroderma
Worst scleroderma, internal organs scarred, anti-topoisomerase antibodyProgressive systemic sclerosis
Tingling in all 4 extremities in a middle aged womenRheumatoid arthritis complication -> Cervical spine compression
Attacks synovium, C1 & C2, more than 8 joints affects, affects middle aged women, cpp, antibody agianst fc portion of IgGRA
RA with splenomegaly & leukopenia -> autoimmune attack of wbc & rbc'sFelty syndrome
RA with GI ulcers & uveitisBechets syndrome
RA with dry mouth and dry eyesSjogrens syndrome ->Complication MALT of parotid
dry eyes and mouth without arthritisSICCA syndrome
ANTI- Ro causes heart block inFetus
4 - EFFECTS of cardiolipin antibodyStimulates the intrinsic factor, Blocks vWF(vWF disease), Spontaneous abortions, False + VDRL
LUPUS + RA + anti-RNPMixed connective tissue disease
Difference between Elastin and collagenElastin do not have hydroxylysines
Destruction of elastinEmphysema
Immunocompromised pts such as Neutropenicchemo pts, burn pts, CF, diabetics should worry ofS.Aureus, Pseudomonas
Immunocompromised pt with Fever start1 antibiotics of S.Aureus & 2 antibiotics of Pseudomonas