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USMLE

General Pathology 1

QuestionAnswer
Antithrombogenic substances
Steps in hemostasis 1. Endothelial injury relases tissue factor (activates factor VII, extrinsic pathway); exposure of thrombogenic subendothelial collagen activates factor XII (intrinsic pathway), release of vWF; decreased synthesis of antithrombogenic substances; 2. Platel
Bernard Soulier syndrome Autosomal recessive. Deficiency of platelet GPIb. Defective platelet adhesion
Glanzman thrombastenia Deficiency of Gp IIB-IIIa; defective platelet aggregation
Immune thrombocytopenic pupura Antiplatelet antibodies and destruction in spleen by macrophages (bing IgG coated platelets via Fc receptor). Thrombocytopenia, prolonged bleeding time, normal PT and PTT. Petechiae, ecchymoses, menorrhagia, nosebleeds. Present in Wiskot-Aldrich
Thrombotic thrombocytopenic purpura Platelet thrombi with scant fibrin with no activation of coagulation system. Fever, thrombocytopenia, hemolytic anemia, neurologic symptoms, renal failure. Increased bleeding time, normal PT/PTT, schistocytes
Hemolytic uremic syndrome Gastroenteritis with bloody diarrhea, fever, thrombocytopenia, renal failure, hemolytic anemia. Produced by verotixin-producing E. coli 0157
Activation of coagulation system Intrinsic pathway (Factor XII): exposure to subendothelial collagen; Extrinsic pathway (factor VII): tissue thromboplastin by endothelium
Kinin cascade Hageman factor converts prekallikrein into kallikrein. HMWK is converted to bradykinin by kallikrein
Fibrinolytic system cascade Kallikrein activates plasminogen into plasmin which inhibits fibrin from coagulation cascade
Vitamin K-dependant factors Factors II, VII, IX, X. Both intrinsic and extrinsic paths need vitamin k-dependant gamma carboxylation
Prothrombin time (PT) Tests extrinsic and common paths. Factors V, VII, X, prothrombin and fbrinogen. Used to monitor warfarin therapy
MOA of warfarin Blocks epoxide reductase (activates vitamin K). Takes 3-4 days for effect due to long half life of previously carboxylated factors which are still circulating
Partial thromboplastin time (PTT) Tests intrinsic and common paths. Factors XII, XI, IX, VIII, X, V, prothrombin, fibrinogen. Used to monitor heparin
DIC Thrombocytopenia, prolonged PT/PTT, decreased fibrinogen, elevated D-dimers
Hemophilia Deficiency of factor VIII or IX. X-linked recessive (affects males). Bleeding at circumcision, hemarthrosis, easy bruising and hematomas. No petechiae or ecchymoses. Normal platelets and bleeding time, normal PT, prolonged PTT (intrinsic path coagulopathy
Increased PT and PTT Vitamin K deficiency, liver disease
Von Willenbrand disease bleeding from mucuous membranes, prolonged bleeding time, normal PT/PTT, abnormal response to ristocetin
Auto mechanics Carbon monoxide poisoning. Decreased SaO2, cherry red color of skin, headache. Rx.: 100% O2
Firefighters Carbon monoxide poisoning. Decreased SaO2, cherry red color of skin, headache. Rx.: 100% O2
Wood stoves and space heaters Carbon monoxide poisoning. Decreased SaO2, cherry red color of skin, headache. Rx.: 100% O2
Pesticide industry Organophosphate poisoning (acetylcholinesterase inhibitors) and arsenic. Lacrimation, salivation, miosis, weakness. Rx.: atropine
Meat packing industry Plyvinyl chloride (PVC). Hepatic angiosarcoma
Coal workers Anthracosis. Pulmonary fibrosis and respiratory distress
Insulation workers Asbestosis. Interstitial lung fibrosis, fibrous pleural plaques, brnchogenic CA, mesotheliomas, recurrent pleural effusions, dyspnea, pleuritic chest pain
Demolition workers Asbestosis. Interstitial lung fibrosis, fibrous pleural plaques, brnchogenic CA, mesotheliomas, recurrent pleural effusions, dyspnea, pleuritic chest pain
Construction workers Asbestosis. Interstitial lung fibrosis, fibrous pleural plaques, brnchogenic CA, mesotheliomas, recurrent pleural effusions, dyspnea, pleuritic chest pain
Shipyard workers Asbestosis. Interstitial lung fibrosis, fibrous pleural plaques, brnchogenic CA, mesotheliomas, recurrent pleural effusions, dyspnea, pleuritic chest pain
Dry cleaners Carbon tetrachloride (CCL4). Liver centrilobular necrosis
Rubber/chemical workers Benzene. Aplastic anemia, leukemia
Battery factory workers Lead poisoning. MOA: denatures ferrochelatase, (microcytic anemia with ringed sideroblasts), denatures ALA dehydrase. Clinical features: depositis in epiphysis, lethargy, cognitive impairment, cerebral edema, lead colic, basophilic stipling. Dx.: blood le
Plumbers Lead poisoning. MOA: denatures ferrochelatase, (microcytic anemia with ringed sideroblasts), denatures ALA dehydrase. Clinical features: depositis in epiphysis, lethargy, cognitive impairment, cerebral edema, lead colic, basophilic stipling. Dx.: blood le
Pottery paint Lead poisoning. MOA: denatures ferrochelatase, (microcytic anemia with ringed sideroblasts), denatures ALA dehydrase. Clinical features: depositis in epiphysis, lethargy, cognitive impairment, cerebral edema, lead colic, basophilic stipling. Dx.: blood le
Combustion of polyurethane foam during fires Cyanide poisoning. Blocks cytochrome oxidase. Hypoxia. Rx.: nitrites (form methhemoglobin which binds cyanide before it reaches tissues), thiosulfate bind cyanide forming thiocyanate
Dental amalgams Mercury poisoning. Intention tremors, dementia, delirium
Insecticides Mercury poisoning. Intention tremors, dementia, delirium
Hat-making industry Mercury poisoning. Intention tremors, dementia, delirium
Cancers produced by cigarette smoke Lung, oral cavity, pharynx, larynx, esophagus, pancreas, kidney
Cardiovascular disease due to cigarette smoke Atherosclerosis (major risk factor), CAD, AMI, Buerger disease
Respiratory disease due to cigarette smoke Chronic bronchitis, emphysema, asthma
Created by: Asclepius