Problem-Based Learning III Test 2

Gastroenteritis What virus?

Noravirus

_______ and ___________ pressures determine movements of fluid between plasma and interstitial fluid.

Oncotic, hydrostatic

HIV drug: inhibits viral integrase, preventing the incorporation of the viral genome into the cell chromosome.

Raltegravir

a type of oxygen-derived free radical whose role in cell injury is well established

Reactive Oxygen Species

_____ secretion is also stimulated by norepinephrine and prostaglandin E2 (PGE2).

Renin

_____-___________ system controls blood pressure and the vascular tone

Renin angiotensin

reduced capacity of cells to divide secondary to progressive shortening of chromosomal ends (telomeres)

Repliactive sensnse

Bronchiolitis, pneumonia What virus?

Respiratory syncitial virus

Active forms of vitamin A (2)

Retinal, retinoic acid

Epithelial cell gene expression: Cell differentiation Growth Apoptosis What Vitamin A substance?

Retinoic Acid

Stored in liver as retinyl palmitate What Vitamin A substance?

Retinol

The period of DNA (and histone) synthesis is the _ phase.

S

Na+ coupled symporters of glucose transporter (2) What type of transport do they use?

SGLT 1 SGLT 2 Active transport

HIV: complexes with CD4 in the endoplasmic reticulum to enable the newly synthesized gp120 to reach the plasma membrane and mediates the release of the virus at the plasma membrane.

Vpu

Verucca vulgaris AKA

Wart

Slim disease AKA

Wasting disease

biotin defeciency causes what?

Widespread injury

The gene for _________ _________ also encodes a copper-transporting P-ATPase and is 60% identical with that of the Menkes gene.

Wilson's disease

Xeroderma Pigmentosum AKA

XP

Bubonic plague What bacteria?

Yersinia pestis

Mycobacterium tuberculosis, M. bovis What disease?

Tuberculosis

Median tongue bud AKA

Tuberculum impar

Francisella tularensis What bioterrorism agent?

Tularemia

___________ determines the final volume and concentration of the urine

Vasopressin

___________ (also known as the antidiuretic hormone, ADH) controls _____ ____________ in the collecting ducts of the kidney.

Vasopressin, water reabsorption

Multiple enzymatic pathways repair a wide range of _________ modifications of DNA

chemical

DNA is also found in mitochondria and in plant chloroplasts, which is consistent with ____________ theories for the origins of these cellular organelles: namely, that they are parasites that adapted to intracellular life by symbiosis.

endosymbiont

After caspsases are activated in apoptosis, ___________ are activated, which degrade all nuclear DNA.

endonucleases

HIV drug: Gp41-mediated virus-cell fusion is inhibited by a peptide drug (T-20, ___________)

enfuvirtide

Cellular Swelilng: Microscopic examination may reveal small, clear vacuoles within the cytoplasm; these represent distended and pinched-off segments of the ___________ ____________

endoplasmic reticulum

Malignancies seen in AIDS patients: •Kaposi sarcoma (_____ ___________ _) •Lymphoma

human herpesvirus 8

Molluscum Contagiousum is caused by a poxvirus. The lesions are small papules with a central depressed crater. In immunocompetent persons, the lesions are self-limiting and are found on the genitals and trunk. In patients with AIDS, multiple lesions (________) are found that do not regress (_% to __% of patients with lesions have lesions of the facial skin)

hundreds, 5, 10

Deamination: ________ repair

excision

Transporters are as specific as enzymes for their substrates, and work by one of two mechanisms: ____________ _________ or ___________ __________

facilitated diffusion, active transport

Vitamins are divided into ___-_______ and _____-_______ vitamins

fat soluble and water soluble

CBC, serum folate leve Tests for what type of anemia? What cell size?

folate defeciency Macrocytic

The caudal border of the part of the developing tongue is marked by the _______ _____ (the site of origin embryologically of the _______ gland).

foramen cecum, thyroid

DNA synthesis proceeds in ________ directions along the ________ and _______ strands of the template DNA

oppoiste, leading, lagging

The clinical syndromes associated with this HIV CD4+ depletion include _____________ infections with fungi, _______ _______ virus, and _____________ bacteria.

opportunistic, herpes simplex, intracellular

The main oral manifestations of HIV/ AIDS are ____ ___________ and _____ ___________ caused by Epstein-Barr virus .

oral candidiasis, hairy leukoplakia

HIV lacks _____________ enzymes to correct errors occurring during conversion of its RNA into DNA via reverse transcription

proofreading

In addition to its polymerase activity, one of the subunits of DNA polymerase III has a ___________ exonuclease activity, which corrects mismatches and assures fidelity in replication of DNA.

proofreading

Disorders of the ___ _____ _____, which in large part consist of the anemias, are of clinical importance in dental practice for several reasons

red blood cells

The method of DNA replication is described as ____-____________ - each replicated duplex, daughter DNA molecule contains one parental strand and one newly synthesized strand.

semi conservative

DNA is replicated by __________ and ________ the strands

separation, copying

Myocardium subjected to persistent increased load, as in hypertension or with a narrowed (________) valve, adapts by undergoing ___________—an increase in the size of the individual cells and ultimately the entire heart—to generate the required higher contractile force.

stenotic, hypertrophy

Vitamin D is a group of closely related _______ produced by the action of ___________ _____ (wavelength ___-___ nm) on ___________ (ergosterol in ______ and 7-dehydrocholesterol in _______)

sterol, ultraviolet light, 290, 310, provitamins, plants, animals

Salivary gland development: The parotid gland is the first to be formed and appears near the angles of the developing mouth (_________)

stomodeum

Abnormal intracellular accumulation: Failure to degrade a metabolite due to inherited enzyme deficiencies. The resulting disorders are called ________ __________

storage diseaes

Literally translated, pathology is the _____ (logos) of _______ (pathos, suffering).

study, diseae

The _______________ gland is the second major salivary gland to develop (late in the 6th week of intra-uterine life).

submandibular

Patients with G-6-PD deficiency exhibit an increased incidence of drug sensitivity, with _____________, aspirin, and chloramphenicol being the prime offenders.

sulfonamides

Fat-soluble vitamins are stored in _______

tissues

Fungi bind to the ____-like receptors (____ and ____) and ______-like receptors (eg, ______-_) on phagocytes.

toll, TLR1, TLR2, lectin, dectin 1

Trace metals - and some vitamins, are _____ in excess

toxic

Vitamin A is _____ in excess

toxic

Vitamin D is ______ in excess

toxic

The two most common types of sickle cell anemia are sickle cell _____ and sickle cell (________) anemia.

trait, disease

What binds vitamin B12 in the ileum and moves it in the blood?

transcobalamin

bariatric surgery AKA

weight loss surgery

Increases Na+ affininty of Na+K+ ATPase tyrosine kinase receptor and phosphorylation of the α-subunit of the enzyme. What hormone?

insulin

Water and electrolytes are constantly exchanged with the environment, and their body content depends on the balance between ______ and ____

intake, loss

Leakage of ____________ __________ through the damaged cell membrane and ultimately into the circulation provides a means of detecting tissue-specific necrosis using blood or serum samples

intercellular proteins

Antigenic stimulation of the immune system in the form of antigen presentation to Th cells can result in the generation of Th1 cells that secrete ____________-_ (__-_) and __________ _____ (___-_____) or Th2 cells that generate IL-_, IL-5, and IL-__

interleukin 2, IL 2, interferon gamma, IFN gamma, 4, 10

Erythrocyte content of ____ affects its absorption from the intestine

iron

Virologic suppression is defined as less than __ copies/mL, and virologic failure is defined as a confirmed viral load of greater than ___ copies/mL in the presence of ART

48, 200

How long does HIV acute phase last?

60 days

Time period of asympttomatic phase of HIV (timeline)

60 days- 10 years

Water is essential for survival and accounts for approximately __% of the body weight in an adult person. This changes with age: it is about __% in the newborn and decreases to below __% in older individuals. Water content is greatest in the _____ tissue (about 90%) and least in the _______ tissue (10%).

60, 75, 50, brain, adipose

The submandibular gland is the second major salivary gland to develop (late in the ___ week of intra-uterine life).

6th

For the Schilling test, the fasting patient receives a small oral dose of radioactive vitamin B12 and then a larger dose of nonradioactive vitamin B12 as a parenteral flush. At 24 hours, the amount of radioactive cyanocobalamin in the urine is measured. About _% of the radioactive vitamin B12 dose is excreted during the first 24 hours; however, persons with ___________ _________ excretes ____ than _%

7, pernicious anemia, less, 3

How much water goes trhough the GI tact daily?

7L

There are at least _ polypeptides (genes) involved in recognition, unwinding and excision repair of UV-induced thymine dimers.

8

DNA damage (seen in ____________) activates an enzyme called ____-___ (______) ______________A, which depletes cellular supplies of nicotinamide adenine dinucleotide, leading to a fall in ATP levels and ultimately necrosis.

APOPTOSIS, poly ADP (ribose) polymerase

Aquaporin 2 AKA

AQP2

Antiretroviral therapy (____) should be used in a manner that will achieve viral suppression and immune reconstitution while at the same time preventing emergence of resistance and limiting drug toxicity.

ART

Actinomycosis What bacteria?

Actinomyces israelii

Stage 1 HIV AKA

Acute Seroconversion Syndrome

Aplastic anemia is most common in young adults (__ to __ years of age) and in persons older than __ years of age

15, 30, 60

A less severe exposure (solid needle or superficial injury) from a source-patient who is asymptomatic or has a low viral load (<____ viral copies/mL) has a _-drug PEP.

1500, 2

Aquaporin 1: Each of the two monomers has _ tandem repeat structures, each consisting of _ membrane-spanning regions and connecting loops embedded in the membrane.

2, 3

Watson-Crick base pairing of nucleotides in DNA. The AT base pairs form _ hydrogen bonds and the GC base pairs form _ hydrogen bonds. Thus, GC-rich regions are ____ stable than AT-rich regions.

2, 3, more

In _ _______ infections, however, a strong antibody response is associated with the dissemination of the fungus.

C immitis

The arthroconidia of _ _______ have an outer wall containing small, cysteine-rich peptides called hydrophobins that have antiphagocytosis properties.

C immitis

_ _______ antigens may elicit a strong Th2 response, thereby directing the immune response away from theTh1 response that would have been able to resolve the infection, as deducedfrom animal experiments.

C immitis

_ _______ conidial cells produce an extracellular protease that can break down immunoglobulins, hemoglobin, collagen, and elastin.

C immitis

_ _______ endospores can survive in phagosomes by producing an alkaline layer.

C immitis

An alkaline protease produced by _ _______ can degrade lung structural proteins and may be an important virulence factor in tissue invasion.

C immitus

The conidial cells of _ _______ produce an extracellular protease that can break down immunoglobulin (Ig) G, IgA, hemoglobin, collagen, and elastin.

C immitus

Humoral immune responses to _ __________ can help resolve the infection, although Th1 responses appear to be more important in this process.

C neoformans

Strains of HIV from patients with advanced disease are more virulent and infect more cell types than strains obtained earlier from the same individual. One explanation may be that HIV develops the ability to use co-receptors in addition to ____ (eg, _____)

CCR5, CXCR4

Carbon Tetrachloride AKA

CCl4

HIV: The destruction of ____ _ cells is caused by a number of factors.

CD4 +

It has been estimated that the plasma half-life of HIV is 5 to 6 hours, 10 billion virions are produced every day, and up to 1 billion ____ cells are generated each day in response to the infection.

CD4+

CTLs have to be activated by helper T cells; thus, when the number of _____ _ cells declines, CTL numbers also decline, contributing to disease progression

CD4+ T

The pathogenesis of the HIV virus involves the gradual depletion of ____ _ cells.

CD4+ T

The pathogenesis of AIDS is directly related to the tropism of the virus for ____ cells and _______ cells, which results in the gradual decline in the number of CD4+ T cells and the subsequent impairment of the ______ system.

CD4+, myeloid, immune

_______ species and other pathogenic fungi have an unusual ability to adhere to human skin and to endothelial and epithelial tissues.

Candida

result of defective catabolism and excessive intake; in macrophages and smooth muscle cells of vessel walls in atherosclerosis

Cholesterol deposition

_________ is the combination of DNA and its associated proteins.

Chromatin

Plasma: Highest anion concentration? Highest cation?

Cl- Na+

H+ K+ ATPase in stomach: The counter-ion ___ is secreted through a ___ ___________, producing hydrochloric acid (___) (_________ acid) in the lumen

Cl-, Cl- channel, HCl, gastric

Retina cells that see during day? Night?

Cones Rods

Problems with cardiovascular in HIV patients?

Confirm cardiovascular status. Some ART drugs can increase risk of cardiovascular disease.

Aspergillis have conidia or sporangiophores?

Conidia

_______________ infection in the lung. Infected cells show distinct nuclear and ill-defined cytoplasmic inclusions.

Cytomegalovirus

Areas of change seen in necrosis (2)

Cytoplasm Nucleus

HIV: recognize and kill actively infected cells that are producing virions and are a very important component of the immune response to infection. What cells?

Cytotoxic CD8+ lymphocytes

recognize foreign antigens presented on the surface of infected host cells and tumor cells What cells?

Cytotoxic T Lymphocytes

4. Which of the following is found during meiosis but not mitosis? a. Chromatids b. Polar microtubules c. Metaphase d. Synapsis e. Cytokinesis

D

Deficiency of vitamin _ produces rickets in children and osteomalacia in adults

D

Important target cells of leptin are found in which organ? a. Small intestine b. White adipose tissue c. Large intestine d. Hypothalamus e. Brown adipose tissue

D

The hormone-sensitive lipase in the cells of adipose tissue acts primarily on what substrate? a. Glucose b. Free fatty acids c. Glycerol d. Triglycerides e. Very-low-density lipoproteins

D

Vitamin _ (calciol) is a hormone

D

The red blood cell GLUT-1 transporter has a high affinity for _-glucose, but 10-20 times lower affinity for the related sugars, _-mannose and _-galactose. The enantiomer _-glucose is not transported; its Kt is more than 1000 times ______ than that of the _-form.

D, D, D, L, higher, D

7-Dehydrocholesterol is synthesized in the liver and is found in the skin. The products of the photolytic reaction are ergocalciferol (vitamin __) and cholecalciferol (vitamin __).

D2, D3

HIV bound on the surface of dendritic cells via the __-____ molecule may infect CD4+ T cells that interact with the dendritic cell during antigen presentation.

DC SIGN

Vitamin _ is the only vitamin that is not usually required in the diet

DCalcium

Dihydropyridine AKA (2)

DHP, NIfedipine

Where does K+ intake come from?

DIet

Deoxyribonucleic acid AKA

DNA

Apoptosis due to ___ _______: Radiation, cytotoxic anticancer drugs, extremes of temperature, and even hypoxia can damage DNA, either directly or through production of free radicals. If repair mechanisms cannot cope with the injury, the cell triggers intrinsic mechanisms that induce apoptosis. In these situations, elimination of the cell may be a better alternative than risking mutations in the damaged DNA, which may progress to malignant transformation. These injurious stimuli cause apoptosis if the insult is mild, but larger doses of the same stimuli result in necrotic cell death. Inducing apoptosis of cancer cells is a desired effect of chemotherapeutic agents, many of which work by damaging DNA.

DNA Damage

Causes of cellular aging (3)

DNA damage Decreased cellular replication Defective protein homeostasis

HIV: A positive-strand DNA is generated by the ___-___________ ___ _____________ activity of the RT

DNA dependent DNA polymerase

the Okazaki fragments are joined by ___ __________ _

DNA polymerase I

Once each RNA primer has been laid down, two ___ ___________ ___ complexes are assembled, one at each of the primed sites.

DNA polymerase III

___________ calcification of the aortic valves is an important cause of aortic stenosis in elderly people

Dystrophic

Mycobacterium tuberculosis Caused by what type of pathogen?

Facultative intracellular bacteria

Tuberculosis caused by what type of pathogen?

Facultative intracellular bacteria

Histoplasma capsulatum What type of pathogen?

Facultative intracellular fungi

Chagas disease Caused by what type of pathogen?

Facultative intracellular protazoa

Trypanosoma cruzi Casued by what type of pathogen?

Facultative intracellular protazoa

Normal tongue. The red spots represent _________ __________. (b) A ___________ tongue where the dorsal surface is grooved.

Fungiform papillae, fissured

Second phase of growth that occurs after replication of DNA inside a cell

G2 phase

Glucose 6 Phosphate Dehydrogenase AKA

G6PD

Heat shock proteins AKA

Hsps

Kaposi sarcoma is a malignant tumor of endothelial cells caused by _____ ____________ _____ _ (____-_).

Human Herpesvirus Type 8, HHV 8

Kaposi's sarcoma causative agent?

Human Herpesvirus-8

Which wins in arterioles: oncotic or hydrostatic pressure? What about in venules?

Hydrostatic Oncotic

_____aldosteronism is a common finding in hypertension

Hyper

____________ is an increase in the size of cells resulting in increase in the size of the organ

Hypertrophy

Western Blot for HIV: Sera from patients are added to the paper, and to visualize the antibodies bound to the HIV proteins, enzyme-labeled antihuman ___ antibodies are added, followed by the chromogenic substrate

IgG

essential for the synthesis of thyroid hormones what mineral?

Iodine

____________ permit net movement of ions only down their electrochemical gradients. .

Ionophores

D glucose Kt = 1-2 Glucose, galactose, mannose Erythrocyte, blood-tissue barriers Which glucose transpoeter?

GLUT 1

D glucose Kt = 15-20 Glucose, fructose Liver, intestine, kidney, pancreatic β-cells, brain Which glucose transporter?

GLUT 2

Reduced glutathione AKA

GSG

Clostridium perfringens, Clostridium septicum What diseases (2)

Gas gangrene Necrotizing cellulitis

Polypeptides AKA

Genes

_ __________ releases a calcium-binding protein, CBP-1, that enables the acquisition of calcium while the yeast cell is inside a macrophage vacuole.

H Capsulatum

antibiotic treatment has been introduced to eradicate _. _______

H. pylori

_______ is the process by which two successive cell divisions produce cells called gametes containing half the number of chromosomes found in somatic cells.

Meiosis

Burkholderia pseudomallei What bioterrorism agent?

Melioidosis

__________ is thought to arise by reprogramming of stem cells to differentiate along a new pathway rather than a phenotypic change (transdifferentiation) of already differentiated cells.

Metaplasai

____________ is a reversible change in which one adult cell type (epithelial or mesenchymal) is replaced by another adult cell type

Metaplasia

change in phenotype of differentiated cells, often in response to chronic irritation, that makes cells better able to withstand the stress; usually induced by altered differentiation pathway of tissue stem cells; may result in reduced functions or increased propensity for malignant transformation

Metaplasia

_______________ anemia associated with iron deficiency. Peripheral blood smear shows red blood cells (____) that are _____ and have marked _____________ central pallor.

Microcytic, RBCs, small, hypochromic

Forms of apthous stomatitis (3)

Minor Major Herpetiform

In a short G2 phase the cell prepares for division during _______ (_)

Mitosis M

In this patient, the lingual frenum extends across the floor of the mouth to become attached to the lingual alveolus behind the mandibular incisors, giving an __________________

Ankyloglossia

Water soluble vitamins (9)

B1 B2 B3 B5 B6 B12 Folate Biotin C

Vitamin ___ deficiency causes pernicious anemia

B12

Apoptosis involves a cascade of events controlled by the ___-_ family of proteins regulating the release of death-promoting factors from mitochondria.

Bcl 2

Cells deprived of growth factors not only activate the pro-apoptotic Bax and Bak but also show reduced levels of ___-_ and ___-__, thus further tilting the balance toward death.

Bcl 2, Bcl XL

if cells are exposed to growth factors and other survival signals, they synthesize anti-apoptotic members of the Bcl-2 family, the two main ones of which are ___-_ and ___-__

Bcl 2, Bcl XL

Diphenhydramine AKA

Benadryl

________ was the first discovered 'deficiency disease'

Beriberi

Trosine Kinase AKA

TK

gp41 AKA

TM

HIV: Gp120 is attached noncovalently to the transmembrane glycoprotein (__) ____, which mediates virus-cell and cell-cell fusion.

TM gp41

Problems with emergencies/urgencies in HIV patients?

None

No signs or symptoms Which stage of HIV?

recent infection

Aquaporin _ is a multisubunit water channel with a glycan unit attached to one of the subunits.

1

GLUT-_, in red blood cells, has a Km of ∼2 mmol

1

The GLUT-_ transporter operates at about 40% of Tmax under fasting conditions (blood glucose concentration of 5 mmol/L; 90 mg/dL); this level of of activity is sufficient to meet the needs of the red cell

1

The final diameter of a chromosome is about _ µm.

1

White fat: These cells each contain primarily _ large ______ droplet (they are _____________), causing the nucleus and remaining cytoplasm to be pushed against the plasmalemma.

1, lipid, unilocular

Angiotensin type that binds to AT1? Type binding to AT2? Type binding to MAS receptors?

1-8 1-8 1-7

In the ICF the concentration of sodium (and chloride) is only __ mmol/L.

10

How long after HIV infection do you get opportunistic infection, wasting, malignancy, dementia?

10 years

The primosome synthesizes short (n ≤ __) ___ oligonucleotides complementary to each parental ___ strand.

10, RNA, DNA

There are typically more than ______ modifications of DNA per cell per day

10,000

In Z-DNA, the base pairs flip ___° relative to the sugar nucleotide bond

180

Several trends in the epidemiology of AIDS have emerged over the decades. In the United States, peak incidence was in ____ and peak incidence of death was 50,877 in ____. The past 2 decades witnessed a decline in the number of cases of AIDS associated with blood and blood products in transfusion and hemophiliac patient groups, specifically attributable to improved testing (starting in ____) of donor blood for HIV antibodies and the heating of factor VIII replacement preparations.

1993, 1995, 1985

Stronger concentrations of epinephrine than what value must be avoided in sickle cell patients?

1:100,000

pancreatic islet β-cells express GLUT-_, with a Km of more than 10 mmol/L (180 mg/d

2

How long after HIV infection do you get mono-like acute phase?

2 months

In planning invasive dental procedures, attention must be paid to the prevention of infection and excessive bleeding in patients with severe immunosuppression, neutropenia, and thrombocytopenia. This may involve the use of prophylactic antibiotics in patients with CD4+ cell counts below ___/µL and/or severe neutropenia (neutrophil count lower than ___/µL)

200, 500

ART currently is recommended when the CD4+ count is less than ___ cells/µL and in those with plasma HIV RNA levels greater than ______ copies/mL.

200, 55,000

During the synthesis of telomeres, the enzyme telomerase, a ribonucleoprotein complex, adds preformed hexanucleotide repeats to the _′-end of the chromosome, using its RNA as a template; there is no requirement for a DNA template

3

Over the past decade, much progress has been made in the treatment of AIDS because of ART and HAART. Both ART and HAART involve use of combinations of antiretroviral drugs; however strictly speaking, HAART is defined as the use of at least _ active antiretroviral medications. Today the terms ART and HAART are essentially equivalent.

3

Telomeres are nucleoprotein complexes that cap the _′ ends of the eukaryotic chromosomes.

3

The incorporation of azido-TTP into DNA blocks further chain elongation, because the _′-azido group cannot form a phosphodiester bond with subsequent nucleoside triphosphates

3

because DNA synthesis adds new nucleotides only at the _′-end of the elongating DNA strand, DNA polymerase III cannot synthesize the lagging strand in one long continuous piece as it does for the leading strand

3

The nucleosome particles themselves are also organized into other, more tightly packed structures, termed ___ Angstrom ________ _________

300, chromatin filaments

HIV: The pathogenesis of the virus involves the gradual depletion of CD4+ T cells. Thus, immune responses controlled by T cells decline. The clinical syndromes associated with this decline include opportunistic infections by fungi, herpes simplex virus, and intracellular bacteria. At this stage, the CD4+ T-cell count in blood is below ___/μL,

350

Patients who have been exposed to the AIDS virus and are HIV-seropositive but asymptomatic may receive all indicated dental treatment. Generally, this is true for patients with a CD4+ cell count of more than ___/uL

350

Brown fat comprises up to _% of the newborn body weight but smaller amounts in adults.

5

DNA synthesis proceeds along the leading strand in a _′ to _′ direction, producing a single, long, continuous strand.

5, 3

Adipocytes of white fat are typically very large cells, ranging in diameter from __ to ___ um

50, 150

Patients who respond to therapy generally show an increase in CD4+ count in the range of __ to ___ cells/µL per year and viral loads of less than __ copies/mL.

50, 150, 75

All dietary forms of vitamin _ are converted to retinol

A

Structure, metabolism and function of vitamin _. Conversion of retinaldehyde to retinoic acid is irreversible

A

Vitamin _ deficiency presents as night blindness

A

Vitamin _ deficiency presents as defective night vision or night blindness (it is the most common symptom of vitamin _ deficiency in children and pregnant women).

A, A

Fat malabsorption may lead to deficiencies of vitamins _, _, _ and _. It may occur as a consequence of diseases of liver or galbladder, inflammatory bowel disease (________ disease, ______ disease) and cystic fibrosis.

A, D, E, K, Chron's, celiac

Healthy adults have about 95% Hb_ (___________) and small amounts of Hb__ (_______________) and Hb_ (_____________)

A, alpha2beta2 A2, alpha2delta2 F, alpha2gamma2

ATP-Binding Cassette AKA

ABC

An unusually wide range of diseases are caused by defects in ___ ______________, including Tangier disease, Stargardt disease, progressive intrahepatic cholestasis, Dubin-Johnson syndrome, pseudoxanthoma elasticum, familial persistent hyperinsulinemic hypoglycemia of infancy (PHHI), adrenoleukodystrophy, Zellweger syndrome, sitosterolemia and cystic fibrosis.

ABC transporters

Antiotensin converting enzyme AKA

ACE

Another form of angiotensin, angiotensin 1-9, is formed by an isoform of ___ (____) and is subsequently degraded to angiotensin 1-7

ACE, ACE2

Adenosine diphosphate AKA.

ADP

adenosine diphosphate AKA

ADP

Anion gap AKA

AG

Alcoholic hyaline in liver Neurofibrillary tangels in neurons What process?

Abnormal protein aggregation

Upper and lower respiratory tract infections, conjunctivitis What virus?

Adenovirus

What does F protein do in G+ bacteria?

Adherance

Trypsanoma spp. disease

African sleeping sickness

Aseptic necrosis AKA

Bone Pain

Retinol AKA (2)

All-trans Vitamin A

2-retinaldehyde AKA (2)

All-trans retinol Vitamin A1

α-1 antitrypsin Storage of nonfunctional protein in hepatocytes causes apoptosis; absence of enzymatic activity in lungs causes destruction of elastic tissue giving rise to emphysema What disease?

Alpha-1-antitrypsin defeciency

Aβ peptide Abnormal folding of Aβ peptides causes aggregation within neurons and apoptosis what disease?

Alzheimer's disease

______________-sensitive epithelial Na+ channel (ENaC) is expressed in the aldosterone-sensitive distal nephron.

Ameoloride

____ _____ is one of the most crucial events in the evolution of disease in any tissue or organ

Cell death

Folate defeciency causes what?

Anemia

__________ anemia. Diffuse gingival hyperplasia with sulcal hemorrhage.

Aplastic

Erythropoietin levels, bone marrow aspirate Test for what type of anemia? What cell size?

Aplastic anemia Normocytic

Normocytic anemias caused by Decreased production of RBCs (3)

Aplastic anemia renal failure Anemia of chronic disease

Characterized by enzymatic degradation of proteins and DNA, initiated by caspases; and by recognition and removal of dead cells by phagocytes

Apoptosis

Regulated mechanism of cell death that serves to eliminate unwanted and irreparably damaged cells, with the least possible host reaction

Apoptosis

Filtration happens on which end of a capillary? Reabsorption?

Arterial Venous

Vegetative hyphae grow on or below the surface of a "solid" growth medium like agar, whereas aerial hyphae extend above the surface of the medium and can produce asexual reproductive structures called conidia (in _____________ species) or sporangiophores (in ___________ species)

Aspergillus, Rhizopus

Issues with analgesics in HIV patients?

Aspirin and other NSAID use can worsen bleeding in a patient who has thrombocytopenia. Avoid during thrombocytopenic episodes. Check drug interactions before use.

Nausea, vomiting, liver, tingling arms/legs Midazolam, triazolam interactions Which HIV drug? Which class?

Atazanavair Protease Inhibitor

Iron defeciency anemia: Increased demand is associated with chronic inflammation--> what type of disease?

Autoimmune disease

refers to lysosomal digestion of the cell's own components

Autophagy

Problems iwth drugs in sickle cell patient

Avoid barbiturates and strong narcotics; sedation may be obtained with midazolam (Versed). When using nitrous oxide, provide oxygen at greater than 50% with high flow rate and good ventilation.

Problems with analgesics in sickle cell patients

Avoid strong narcotics and high doses of salicylates. Use acetaminophen with or without small doses of codeine (

the first successful anti-HIV therapy.

Azidothymidine

Transitions in the cell cycle from one phase to the next are regulated by protein kinases whose activity depends on what other proteins? a. Tumor suppressors b. Cyclins c. Actins d. Lamins e. Importins

B

What are the relatively large particles formed in the intestinal epithelial cells and rich in ingested lipids? a. Fatty acids b. Chylomicrons c. Glycerols d. Very-low-density lipoproteins e. Adipocytes

B

Which of the following is a region of chromatin that is well developed in large neurons active in protein synthesis? a. Heterochromatin b. The nucleolus c. The Nissl substance (neuronal RER) d. The Barr body e. The nucleosome

B

Water soluble vitamins (2)

B C

The main fungal pathogens that can infect apparently healthy hosts and avoid the immune system include which 4?

B dermatitidis Η capsulatum C immitis P brasiliensis.

•Maraviroc (CCR5 inhibitor; Selzentry, Pfizer) •Enfuvirtide (T-20; Fuzeon, Trimeris/Roche) What class of anti-HIV drugs?

Binding and Fusion Inhibitors

Complications of sickle cell anemia can occur at any age, but patients in the following age groups are more likely to manifest certain complications (3)

Birth to 20 years 20 to 40 40 and up

Silver stain preparation of brain tissue from a patient with Lyme disease meningoencephalitis. Two helical spirochetes (___________ ___________)

Borrellia burgdorferi

Lyme disease What bacteria?

Borriella. burgdorferi

Clostridium botulinum toxin What bioterrorism agent?

Botulism

Pharyngeal arch AKA

Branchial Arch

The yeast-to-hyphal transformation of _ ________ is central to its penetration through epithelial cell surfaces.

C albicans

Although _ _______ endospores are phagocytosed readily by alveolar macrophages, they can survive in phagosomes, producing an alkaline layer resulting from the production of ammonia or ammonium ions.

C immitis

_____ fat comprises up to 5% of the newborn body weight but smaller amounts in adults.

Brown

Brucella species What bioterrorism agent?

Brucellosis

________ can form biofilms alone or in conjunction with other microorganisms on these surfaces, creating a medically challenging condition, because the biofilms have reduced susceptibility to antifungal agents.

Candida

________ species and other pathogenic fungi have an unusual ability to adhere to human skin and to endothelial and epithelial tissues

Candida

Botulism (paralytic food poisoning) What bacteria?

Clostridium botulinum

Tetanus (lockjaw) What bacteria?

Clostridium tetani

Virtamin B12 AKA

Cobalamin

Vitamin B12 AKA

Cobalamin

Problems with anesthesia in sickle cell patients

Consider using local anesthetic without epinephrine for routine dental care. For surgical procedures, use 1:100,000 epinephrine in local anesthetic. Avoid general anesthesia, particularly if the hemoglobin level is below 10 g/dL.

Problems with consultation in Sickel cell patient

Consult with patient's physician before surgical procedures are performed.

_______ scavenges superoxide and other reactive oxygen species

Copper

2nd pharyngeal arch AKA

Copula

A variety of metabolic insults that accumulate over time may result in damage to nuclear and mitochondrial ___. Although most ___ damage is repaired by ___ _______ enzymes, some persists and accumulates as cells age. Some aging syndromes are associated with defects in ___ repair mechanisms, and the life span of experimental animals in some models can be increased if responses to ___ damage are enhanced or proteins that stabilize ___ are introduced. A role of free radicals in ___ damage leading to aging has been postulated but remains controversial.

DNA, DNA, DNA repair, DNA, DNA, DNA, DNA

Chromatin contains ___, ___ and _______, plus _________ and _______ counterions

DNA, RNA, protein, organic, inorganic

Accumulation of damaged ____ and misfolded __________: triggers apoptosis

DNA, proteins

cell injury results when cells are stressed so severely that they are no longer able to adapt or when cells are exposed to inherently damaging agents or suffer from intrinsic abnormalities (e.g., in ___ or _________).

DNA, proteins

Rotairus disease?

Diarrhea

Genetic aberrations can result in pathologic changes as conspicuous as the congenital malformations associated with ____ ___________ or as subtle as the single amino acid substitution in hemoglobin _ giving rise to ______ ____ ________

Down Syndrome, S, Sickle cell anemia

Most water intake comes from where?

Drink

A newborn boy is diagnosed with Apert syndrome. He has craniosynostosis, hypoplasia of the middle part of the face with retrusion of the eyes, and syndactyly that includes fusion of the skin, connective tissue, and muscle of the first, middle, and ring fingers with moderate fusion of those digits. There is very limited joint mobility past the first joint. Which one of the following is most likely decreased in cells of the interdigital regions of the developing hand of this newborn child? a. Random DNA degradation b. Inflammation c. Cell swelling d. Bcl-2 e. DNA degradation by endonucleases

E

What viruses have been found throughout the human chromosomes, but they do not produce virions?

Endogenous retroviruses

Sarcoplasmic reticulum AKA

Endoplamsic reticulum

Necrosis: Change in cell size? Nucleus changes? Plasma membrane changes? Cellular contents? Adjacent inflammation? Pathologic or physiologic?

Enlarged Pynkosis-->karryorhexis-->karyolysis Disrupted Enzymatic digestion, may leak out Frequent Always pathologic

Problems with breathing in HIV patients?

Ensure that patient does not have a pulmonary infection. Delay treatment until pulmonary infections are resolved.

What C. perf exotoxin can be a bioterrorism aget?

Epsilon toxin

Infectious mononucleosis What virus?

Epstein Barr virus

Nucleosome-Free DNA AKA

Exposed DNA

Pneumonia is caused by what type of pathogen?

Extracellualr bacteria

Fas ligand (____) is a membrane protein expressed mainly on __________ _ ______________

FasL, activated T lymphocytes

Adipose Tissue AKA

Fat

___ malabsorption reduces vitamin E absorption

Fat

What form is iron incorportated into transferrin?

Fe3+

patients who have or who are at risk of developing abnormalities of water or electrolyte balance need a daily record of fluid intake and loss. What test?

Fluid balance chart

LDL receptor Loss of LDL receptor leading to hypercholesterolemia what disease?

Fmailal hypercholesterolemia

_____ absorption and metabolism are interfered with by alcohol consumption and certain drugs (methotrexate, phenytoin [Dilantin])

Folate

______ deficiency is one of the commonest vitamin deficiencies

Folate

Nausea, vomiting Midazolam, triazolam interactions Which HIV drug? Which class?

Fosamprenavir Protease inhibitor

Tularemia What bacteria?

Francisella tularensis

_____ and __________ are the best sources of vitamins

Fruit, vegetables

Nieserria gonnorrhea disease?

Gonnorrhea

Nieserria gonnorrhea AKA

Gonococcus

Found in 5% of HIV-infected patients and can occur any time during the infection. Bilateral swelling of the parotid is most common. In some patients, CD8+ lymphocytes infiltrate the gland and are associated with lymphadenopathy. Xerostomia may occur. Patients are at increased risk for B cell lymphoma. Which oral HIV condition?

HIV related salivary gland disease

The definition of AIDS provided by the CDC has been revised several times over the years, and in 2008 it was revised to be laboratory-confirmed evidence of ___ infection in a person who has stage _ ____ infection (i.e., a ____ lymphocyte count less than ___ cells/µL)

HIV, 3, HIV, CD4+, 200

AIDS What viruses (2)

HIV-1 HIV-2

Human Immunodefeciency Virus 1 AKA

HIV1

Sickle cell hemoglobin (___) was the first Hb variant of the more than 600 inherited human Hb variants (___________________) to be recognized.

HbS, hemoglobinopathies

____ _____ ________ are expressed in fungi in response to exposure to high temperature and other adverse conditions such as starvation

Heat shock proteins

Deficiency of glucose 6-phosphate dehydrogenase: Peripheral blood film shows _____ _______ in red blood cells and a single ____________. (Supravital new methylene blue stain.)

Heinz bodies, reticulocyte

Acute viral hepatitis What virus?

Hepatitis A

Acute or chronic hepatitis What virus?

Hepatitis B virus

Acute or chronic hepatitis What virus?

Hepatitis C virus

With hepatitis B virus infection: acute or chronic hepatitis What virus?

Hepatitis D Virus

Acute viral hepatitis What virus?

Hepatitis E virus

increased cell and organ size, often in response to increased workload; induced by growth factors produced in response to mechanical stress or other stimuli; occurs in tissues incapable of cell division

Hypertrophy

The principal adaptive responses are what? (4)

Hypertrophy Hyperplasia Metaplasia Atrophy

___________ may prolong PR interval, cause peaked P-wave, flatten the T-wave and cause prominent U-waves.

Hypokalemia

Oxygen demand AKA

Hypoxia

Interleukin 2 AKA

IL-2

covalent modification of cellular proteins, lipids, nucleic acids Result of what?

Increased ROS

Osteopetrosis AKA

Increased bone density

activation of enzymes that damage cellular components and may also trigger apoptosis Result of what?

Increased intracellular Ca2+

Most common cause of anemia in clinical practice (3)

Inflammation Neoplasia Chronic disease

Influenza virus Disease?

Influenza

Influenza virus What disease?

Influenza

Lack of blood flow

Ischemia

Protozoan opportunistic infections in AIDS patients: •Toxoplasmosis •Cryptosporidiosis •________ _____ infection •__________ ___________ infection

Isosopora b elli Entamoeba histolytica

Progressive multifocal leukoencephalopathy (opportunistic) What virus?

JC virus

Where is B6 absorbed?

Jejunum

Ways of increasing HIV expression: __________-mediated delivery to infected cells of suicide gene constructs that are activated only in HlV-expressing cells.

Lentivirus

Where are baroreceptors located in the kidney?

Juxtaglomerular apparatus

Fat soluble vitamin that acts as a coenzyme

K

Na+ H+ ATPase is ubiquitous in which organs (2)

Kidney Heart

lymphadenopathy associated virus AKA

LAV

Linear gingival erythema AKA

LGE

Tetanus KA

Lockjaw

Study AKA

Logos

Abdominal discomfort Rifampin interaction Which HIV drug? Which class?

Lopinavir Protease inhibitor

Borriela burgdorferi disease

Lyme disease

Mitosis AKA

M

Plasmodium spp, disease

Malaria

Candida albicans cell wall: Components of outer membrane (3) Components of inner membrane (3)

Mannan cell wall proteins beta-1,6 glucan beta-1,3-glucan Chitin Cell membrane

Curettage, cryosurgery, and cautery have been used to treat these lesions, but they are painful and recurrences are common. Resolution of multiple lesions has been reported with HAART. Which oral HIV condition?

Molluscum contagiosum

Culmination of irreversible cell injury leads to what?

Necrosis

increased eosinophilia; nuclear shrinkage, fragmentation, and dissolution; breakdown of plasma membrane and organellar membranes; abundant myelin figures; leakage and enzymatic digestion of cellular contents

Necrosis

the type of cell death that is associated with loss of membrane integrity and leakage of cellular contents culminating in dissolution of cells, largely resulting from the degradative action of enzymes on lethally injured cells.

Necrosis

Nipah virus, hantavirus, possibly others What type of bioterrorism agent?

Newly emerging threats

Gonnorrhea What bacteria?

Nieserria gonnorrhea

_________ ______ have a radius of about 9.0 nm (90 Å) through which larger proteins and nucleic acids enter and leave the nucleus.

Nuclear pores

Initiation AKA

Nucleation

•Azidothymidine (AZT, zidovudine; Retrovir, GlaxoSmithKline) •Dideoxycytidine (ddC, zalcitabine; Hivid, Roche) •Dideoxyinosine (ddl, didanosine; Videx, Bristol-Myers Squibb) •Stavudine (d4T; Zerit, Bristol-Myers Squibb) •Tenofovir disoproxil fumarate (Viread, Gilead) •Lamivudine (3TC; Epivir, GlaxoSmithKline) •Abacavir sulfate (ABC; Ziagen, GlaxoSmithKline) •Emtricitabine (Emtriva, Gilead) What class of anti-HIV drug?

Nucleoside Analog Reverse Transcriptase Inhibitors

Progressive multifocal leukoencephalopathy is what type of infection?

Opportunistic

_______________ mycoses are seen in immunosuppressed or debilitated individuals, or those with catheters, and are caused by normally commensal fungi, including Candida and Aspergillus.

Opportunistic

Kidney, liver, bone marrow all examples of what?

Organs

Vasopressin is more sensitive to changes in volume or osmotic pressure?

Osmotic pressure

Ex Vivo AKA

Outside the body

Condyloma; cervical carcinoma What virus?

Papillomavirus

Botulism AKA

Paralytic food poisoning

________ live on or within a host and benefit from this association, whereas the host is usually harmed.

Parasites

An early sign of HIV infection, found in about 70% of infected patients during the latent stage of infection. Must be present longer than 3 months and in two or more extrainguinal locations. Anterior and posterior cervical, submandibular, occipital, and axillary nodes are most frequently involved. What HIV oral contiditoin?

Persistent generalized lymphadenopathy

Branchial arch AKA

Pharyngeal arch

______ ________ separates the intracellular and extracellular fluid

Plasma membrane

Streptococcus pneumonia AKA

Pneumococcus

_________ _______ are especially at risk of deficiency of vitamin K and may develop the hemorrhagic disease of the newborn

Premature infants

Essential hypertension AKA

Primary hypertension

•Saquinavir mesylate (Invirase, Roche) •Tipranavir (Aptivus, Boehringer Ingelheim) •Darunavir (Prezista, Tibotec) •Ritonavir (Norvir, Abbott) •Indinavir (Crixivan, Merck) •Lopinavir + ritonavir (Kaletra, Abbott) •Nelfinavir (Viracept, Agouron) •Fosamprenavir (Lexiva, GlaxoSmithKline) •Atazanavir (Reyataz, Bristol-Myers Squibb/Novartis) •Nelfinavir mesylate (Viracept, Agouron) What class of anti-HIV drugs?

Protease Inhibitors

Nutritional defeciencies leading to cell injury: ________-__________ insufficiency among underprivileged populations is only the most obvious example; specific _______ deficiencies are not uncommon even in developed countries with high standards of living

Protein calorie, vitamin

_________ _________ and ____________ are involved in over 100 reactions in carbohydrate (including the glycogen phosphorylase reaction), lipid, and particularly amino acid metabolism, and the metabolism of one-carbon units

Pyridoxal phosphate, pyridoxamine

Coxiella burnetti What bioterrorism agent?

Q fever

The type of HIV that initially infects a person, for example via sexual contact, is the __ _____, which binds to both the CD4 receptor and the CCR5 chemokine receptor that are found on monocytes, macrophages, and dendritic cells.

R5 virus

The retinoid acid receptors (_____) bind ___-_____- and _-___-________ ____, while the so-called rexinoid receptors (RXRs) bind the 9-cis isomer only.

RARs, all trans, 9 cis retinoid acid

HIV: promotes the transport of unspliced mRNA into the cytoplasm. Only Rev, Tat, and Nef are synthesized from fully spliced mRNA. The RNAs encoding the other genes are not spliced and hence would not normally be transported into the cytoplasm. Thus, Rev plays a crucial role in the production of viral proteins by binding to the Rev-responsive element in the env region of the viral RNA and transporting the latter into the cytoplasm.

Rev

Effective treatments of the HIV viral infection rely on detailed knowledge of the viral life cycle. For the AIDS virus, the viral genome is RNA. In the infected cell, it is copied into a DNA form by a viral enzyme termed _______ ____________

Reverse transcripatse

An Na+-coupled glucose symporter _____, driven by a Na+ gradient formed by Na+/K+-ATPase, transports glucose into the intestinal epithelial cell, while ____-_ facilitates the downhill movement of glucose into the portal circulation

SGLT 1, GLUT 2

D glucose Kt = 1.6 Glucose (1Na+/1 glucose) Kidney Which glucose transporter?

SGLT 2

Much smaller amounts of glucose are recovered by _____ in a later segment of the renal tubule, which couples transport of one molecule of glucose to two sodium ions.

SGLT1

Glucose is reabsorbed primarily by _____ ( _-to-_) Na+: Glc stoichiometry) into renal proximal tubular epithelial cells.

SGLT2, 1, 1

=Syndrome of Inappropriate Antidiuretic Homrone AKA

SIADH

characterized by capillary fragility causing subcutaneous and other hemorrhages, muscle weakness, soft, swollen, bleeding gums, loosening of teeth, poor wound healing and anemia. What disease? Defeciency of what?

Scurvy Vitamin C

autophagy AKA

Self eating

Reduced cell size in apoptosis AKA

Shrinkage

Peripheral blood smear shows characteristic abnormal sickle-shaped red blood cells (RBCs). What condition?

Sickle cell anemia

Host defenses against infection include: ○____: tough keratinized barrier, low pH, fatty acids ○____________ system: alveolar macrophages and mucociliary clearance by bronchial epithelium, IgA ○__________________ system: acidic gastric pH, viscous mucus, pancreatic enzymes and bile, defensins, IgA, and normal flora ○_____________ tract: repeated flushing and acidic environment created by commensal vaginal flora

Skin respiratory gastrointestinal urogenital

Variola major virus What bioterrorism agent?

Small pox

______, _________ molecules (such as O2, CO2, N2) and _________ polar molecules (such as urea, ethanol, and small organic acids) move through membranes by simple diffusion without the aid of membrane proteins

Small, nonpolar, uncharged

important minerals for the maintenance of osmolality of the extracellular fluid and cell volume (2)

Sodium Potassium

The dissociation is reversible and, on cooling, the complementary nucleotide sequences reassociate or reanneal to reform their original base pairs. This is the basis for one of the primary methods for DNA analysis, ______ _____________

Southern hybridization

Rhizopus have conidia or sporangiophores?

Sporangiophores

Early symptomatic stage AKA which stage of HIV?

Stage 2

____________ mycoses are caused by trauma to the skin, involve the deeper skin layers, and include lymphocutaneous sporotrichosis (caused by Sporothrix schenckii).

Subcutaneous

Sulfonamide example

Sulfomethxole

_____________ mycoses are limited to the outer layers of the skin and are not considered to be destructive.

Superficial

Enlarged nucleus AKA

Swelling nucleus

_________ live together with their host, and this relationship generates a mutual advantage for each organism.

Symbionts

Ways of increasing HIV expression: Genetic modification of patient peripheral blood cells to express _-cell receptors that can efficiently recognize viral antigens.

T

Transverse Tubules AKA

T Tubules

Patients who demonstrate various laboratory changes (i.e., lymphopenia: _ _______/_ __________ ratio usually less than _) in addition to HIV antibody positivity also may show clinical signs or symptoms, such as enlarged lymph nodes, night sweats, weight loss, oral candidiasis, fever, malaise, and diarrhea

T helper, T suppressor

HIV: As the viral gp120 mutates late in the course of the disease, the virus becomes _-______ and binds to both CD4 and the CXCR4 chemokine receptor

T tropic

Later, during chronic infection of a person, the gp120 gene undergoes mutations and the new gp120 binds to the chemokine receptor CXCR4, expressed primarily on T cells; the virus is then said to be "_-_______" or an "__ virus"

T tropic, X4

Once HIV has gained access to the bloodstream, the virus selectively seeks out T lymphocytes (specifically __ or _ ______ lymphocytes)

T4, T Helper

Endoplasmic reticulum Peptide Presentation of peptides for immune response Which primary active transporter?

TAP

Hexosaminidase β subunit Lack of the lysosomal enzyme leads to storage of GM2 gangliosides in neurons What disease?

Tay-Sachs disease

Chromosomal ends

Telomeres

Microcytic anemia caused by Defective hemoglobin synthesis Which anemai?

Thallassemia

Problems with drugs in HIV patients?

There are many drug interactions and drug toxicities associated with ART. Clinicians are advised to check drug reference resources before prescribing medications to patients on ART, to minimize drug interactions. Also, some ART drugs can cause mucosal eruptions

________ deficiency is associated with alcoholism

Thiamine

Oral candidiasis AKA

Thrush

In contrast to simple diffusion, in which the rate of transport is directly proportional to the substrate concentration, facilitated diffusion is a saturable process, having a maximum transport rate, ____

Tmax

Rickettsia prowazekii What bioterrorism agent?

Typhus fever

Ultraviolet light AKA

UV light

Brucellosis AKA

Undulant fever

__________, _________, and _________ are examples of secondary active transport

Uniport, antiport, symport

Glucose transporters AKA

Uniporters

Most water loss comes from where?

Urine

____________ hyphae grow on or below the surface of a "solid" growth medium like agar, whereas _______ hyphae extend above the surface of the medium and can produce asexual reproductive structures called conidia (in Aspergillus species) or sporangiophores (in Rhizopus species)

Vegetative, aerial

When scaling a patient with HIV, when should you consider antibacterial therapy?

When CD4+ count is less than 200/uL or if unresponsive to treatment

______ adipose tissue is found in many organs throughout the body, typically forming about 20% of the body weight in adults.

White

In _-DNA, the base pairs flip 180° relative to the sugar nucleotide bond. This results in a novel conformation of the base pairs relative to sugar phosphate backbones, yielding a form of DNA with a zigzag configuration (hence the name _-DNA) along the sugar phosphate backbone

Z, Z

____ deficiency affects growth, skin integrity and wound healing

Zinc

____ is a component of numerous (approximately 100) enzymes associated with carbohydrate and energy metabolism, protein synthesis and degradation, and nucleic acid synthesis

Zinc

Sweat has _____ chloride compared to ECF

`low

When rhodopsin is exposed to light, it is bleached; the retinal dissociates and is isomerized and reduced to ___-____-_______

all trans retinal

Neutrophils can more readily digest P brasiliensis strains that lack the _____-_-_ _______

alpha 1 3 glucan

Wild-type H capsulatum with cell walls that contain _____-_-_ _______ not only survive within macrophages but also undergo cell division, eventually killing the host cell

alpha 1, 3 glucan

Snake venoms such as _____-__________________, and tetrodotoxin from the puffer fish inhibit _______-dependent ___ channels

alpha bungarotoxin, voltage, Na+

Ninety percent of vitamin E present in human tissues is in the form of the natural isomer, _____-__________

alpha tocopherol

Iron deficiency causes ______

anemia

Structural analogues of folate are used as ___________ and ___________ _____

antibiotics, anticancer drugs

•Accumulation of damaged DNA and misfolded proteins: triggers ____________

apoptosis

Autophagy: In this process, intracellular organelles and portions of cytosol are first sequestered within an ___________ ________, which is postulated to be formed from ribosome-free regions of the ER

autophagic vaculole

The renin-angiotensin-aldosterone system is the principal regulator of the ______ ________ and ________ ____

blood pressure, vascular tone

Biotin is important for _____________ reactions

carboxylation

Metaplasia of normal __________ to ___________ epithelium (right) in a bronchus

columnar, squamous

Patients with advanced HIV infection or AIDS have an altered ratio of CD4+/CD8+ lymphocytes, a decrease in total number of lymphocytes, thrombocytopenia, anemia, a slight alteration in the humoral antibody system, and a decreased ability to show delayed allergic reactions to skin testing (_________ ______)

cutaneous anergy

Infections of the keratinized skin, hair, and nails by fungi are classified as _________ _______ and are caused by dermatophytes, which include the genera Epidermophyton, Trichophyton, and Microsporum.

cutaneous mycoses

The major causes of ATP depletion are reduced supply of oxygen and nutrients, mitochondrial damage, and the actions of some toxins (e.g., ________)

cyanide

The initiation of DNA synthesis is triggered by the action of the CDC7 kinase together with other ______-_________ _________

cyclin dependent kinases

The passage of cells through the cell cycle is tightly controlled by a variety of proteins termed ______-_________ _______

cyclin dependent kinases

Cell cycling is controlled by the sequential appearance of key cytoplasmic proteins, the _______, which bind ______-_________ _________

cyclins, cyclin dependent kinases

A thymine dimer consists of a ___________ ring joining a pair of adjacent _______ nucleotides.

cyclobutane, thymine

Telophase ends with ___________ or cell cleavage into two daughter cells by a contractile ring of actin filaments and myosin.

cytokinesis

Reversible cell injury: cell swelling, fatty change, plasma membrane blebbing and loss of microvilli, mitochondrial swelling, dilation of the ER, eosinophilia (due to decreased ___________ ____)

cytoplasmic RNA

______________ __________ act as anchors connecting the plasma membrane to the cell interior, and serve many functions in maintaining normal cellular architecture, motility, and signaling. Activation of proteases by increased cytosolic Ca2+ may cause damage to elements of the cytoskeleton, leading to membrane damage.

cytoskeletal filaments

Vitamin A is stored in the liver in the form of retinol and retinyl esters (_______ _________), bound to the _________ _______-______ _______ (____)

cytosolic retinol binding proteins, CRBP

Activation of the Th1 pathway stimulates phagocytosis and the production of _________ ____ _ cells and opsonizing antibodies, resulting in a protective effect against fungal infections.

cytotoxic CD8+ T

Apoptosis: Cell death induced by _________ _ ___________, a defense mechanism against viruses and tumors that serves to kill virus-infected and neoplastic cells

cytotoxic T lymphocytes

Vitamin D deficiency is also characterized by _________ circulating concentrations of calcium and an _________ serum alkaline phosphatase activity

decreaesd, increased

Water is obtained from the ____ and from _________ __________, and is lost through the kidneys, skin, lungs, and the intestine. Note how much water enters and leaves the gastrointestinal tract daily; this explains why severe diarrhea quickly leads to ___________.

diet, oxidative metabolism, dehydration

Cells have developed many mechanisms to remove _____ _________ and thereby minimize injury

free radicals

= Feces in diarrhea has ____ HCO3- compared to ECF

high

Usually, no treatment is indicated. Single lesions may have to be biopsied so that melanoma can be ruled out. Patients with Addison disease may require corticosteroids. Which oral HIV condition?

hyperpigmentation

Molds are multicellular structures with tubular, elongated structures called ______

hyphae

Water excess __________ plasma volume, renal blood flow, and GFR

increases

The nuclear envelope is supported internally by a meshwork, the nuclear lamina, composed of intermediate filament subunits called ______

lamins

With seroconversion in HIV, A concomitant, transient fall in CD4+ cells occurs (_____________, along with ____ titers of plasma HIV), but patients do not develop evidence of immunosuppression

lymphopenia, HIV

Under some circumstances cells may accumulate abnormal amounts of various substances, which may be harmless or associated with varying degrees of injury. The substance may be located in the cytoplasm, within organelles (typically ___________), or in the nucleus, and it may be synthesized by the affected cells or may be produced elsewhere.

lysosomes

Role of mitochondria in cell injury and death. Mitochondria are affected by a variety of injurious stimuli and their abnormalities lead to __________ or __________.

necrosis, apoptosis

When HIV proteins distort cellular regulation, or when nonintegrated circular viral DNA accumulates in nonpermissive (_______________) CD4 T cells, the cells may undergo programmed cell death (_________). The HIV envelope alone, or that bound to antibodies, may impart an inappropriate signal to CD4+ cells, forcing them to initiate apoptosis.

nonactivated, apoptosis

Problems with allergies in sickel cell patients

none

Problems with cardiovascular in sickel cell patients

none

Renin secretion is also stimulated by _______________ and prostaglandin __

norepinepherine, E2

The diagnosis of aplastic anemia is based on the presence of anemia (____________, ______________), thrombocytopenia (__________ sized platelets), neutropenia, and no abnormal cells in the leukocyte differential.

normochromic, normocytic, normal

Renin is a ________ that uses circulating _______________ as its substrate. Renin secretion is regulated by pathways involving G-protein-coupled receptors and adenylate cyclase - PKA pathway, which activates the ____-_______ _______ _______ (____)

protease, angiotensinogen, cAMP responsive binding protein, CREB

Cells _______ themselves against changes of osmolality and volume

protect

Within certain limits, injury is __________, and cells return to a stable baseline; however, if the stress is severe, persistent and rapid in onset, it results in ____________ injury and death of the affected cells

reversible, irreversible

30% to 60% of persons with ___________ ____________ (who more commonly are _______) have iron defecneinty anemia.

rheumatoid arthritis, women

Vitamin A is a component of the visual pigment _________, which is found in the ___ cells of the retina and is formed by the binding of __-___-_______ to the apoprotein opsin.

rhodopsin, rod, 11 cis retinal

7-Dehydrocholesterol is synthesized in the _____ and is found in the ____. The products of the photolytic reaction are ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). They are equipotent and both are converted to a series of hydroxylated derivatives, in the _____ to 25-hydroxycholecalciferol (25(OH)D3; _________) and then in the ______, to the active compound 1α-,25-dihydroxycholecalciferol (1,25(OH)2D3; ___________).

skin, liver, liver, calcidiol, kidney, calcitriol

Beta carotene is converted in the _____ ______ to _____-_____ _______ by the action of the β-carotene dioxygenase.

small bowel, all trans retinal

The mitochondrial genome is _____ in size, circular, and encodes relatively ___ proteins

small, few

The rate of decay of superoxide is significantly increased by the action of ___________ ____________ found in many cell types.

superoxide dismutases

Chickenpox, shingles What virus?

varicella zoster virus

Sickle cell screening: •Screening tests include ______ blood cell count with _______________, _____________ or hematocrit determination, ______ smear, and ___________ test.

white, differential, hemoglobin, blood, Sickledex

Key differences between apoptotic and necrotic cell death include which of the following? a. Apoptotic cells do not release factors that induce inflammation. b. Necrosis does not trigger inflammation. c. Apoptosis does not utilize intracellular proteases. d. Apoptosis usually follows lethal physical damage to a cell. e. Necrosis is involved in formation of some organs during embryonic development.

A

Vitamin _ is a generic term for retinol, retinal and retinoic acid, all of which are found in _______

A

Vitamin _ is stored in the liver and needs to be transported to its sites of action

A

Fat soluble vitamins that act as hormones (2)

A D

Fat soluble vitamins that can be toxic in excess (2)

A D

Vitamins that act as hormones (2)

A D

Fat soluble vitamins (4)

A D E K

defective DNA repair mechanisms; conversely DNA repair may be activated by calorie restriction, which is known to prolong aging in model organisms

Accumulation of DNA damage

How to identify Mycobacteria, nocardiae (modified)

Acid-Fast Stain

Another form of angiotensin, angiotensin _-_, is formed by an isoform of ACE (ACE2) and is subsequently degraded to angiotensin _-_

1 9, 1 7

When the CD4+ T-cell concentration falls below ____/μL and the virus load is above ______ RNA copies/mL, "full-blown AIDS" is manifested, with HIV wasting syndrome, neurologic symptoms, and malignancies.

200, 75,000

ART is strongly recommended for patients with CD4+ T cell counts lower than ____/µL and for those with ____

200, AIDS

Dystrophic calcificaiton: Initiation in extracellular sites occurs in membrane-bound vesicles about ___ nm in diameter; in normal cartilage and bone they are known as _______ __________, and in pathologic calcification they derive from degenerating cells.

200, matrix vesicles

When the CD4+ count drops to below ___ cells/µL, the person has AIDS and is susceptible to opportunistic infections, including ____________ pneumonia, toxoplasmosis, cryptococcosis, influenza, histoplasmosis, tuberculosis, _______________ infection, mucocutaneous diseases such as candidiasis, and neoplasms previously discussed

200, pneumocystis, cytomegalovirus

XP: a group of rare, life-threatening, autosomal recessive disorders (incidence = 1/_______) that are marked by extreme sensitivity to sunlight

250,000

Size of angiotensinogen Size of antgiotensin I Size of angiotensin II

255 AA 10 AA 8 AA

Catalase reaction

2H2O2 → O2 + 2H2O

The hypopharyngeal eminence rapidly overgrows the ___ arch (the _______) to merge with the ___ arch swellings.

2nd, copula, 1st

The HIV genome has _ main gene clusters: Name them!

3 gag, pol, env

Treatment of major lesions that persist involves potent topical or intralesional corticosteroids. Systemic steroids generally are avoided, to prevent further immunosuppression. Thalidomide treatment has yielded good response but should be used for only a short time, because the drug can enhance HIV replication. Granulocyte colony-stimulating factor has produced significant improvement in a limited number of patients. Which oral HIV condition?

Apthous Stomatitis

About 66% of lesions are of the more uncommon forms—major and herpetiform. With more severe reduction of CD4+ cell count, major lesions become more prevalent. Lesions that are chronic or atypical, or that do not respond to treatment, should be biopsied. Which oral HIV condition?

Apthous stomatitis

Each of the two monomers has two tandem repeat structures, each consisting of three membrane-spanning regions and connecting loops embedded in the membrane. Which aquaporin?

Aquaporin 1

__________ are membrane channel proteins which transport water

Aquaporins

Autophagy. Cellular stresses, such as nutrient deprivation, activate autophagy genes (___ ______), which initiate the formation of membrane-bound ____________ in which cellular organelles are sequestered. These vesicles fuse with _____________, in which the organelles are digested, and the products are used to provide nutrients for the cell. The same process can trigger ___________, by mechanisms that are not well defined.

Atg genes, vesicles, lysosomes, apoptosis

________, _______, and ________ are combinations of three antiretrovirals, and _______, _________, _______, and _________ are combinations of two nucleoside-nucleotide reverse transcriptase inhibitors

Atripla, Epzicom, Trizivir, Combivir, Epzicom, Trizivir, Truvada

decreased cell and organ size, as a result of decreased nutrient supply or disuse; associated with decreased synthesis of cellular building blocks and increased breakdown of cellular organelles

Atrophy

Mycobacterium kansasii,* Mycobacterium avium complex* What disease?

Atypical mycobacterial infections

The schema of tongue primordia. (a) The ventral wall of the pharynx in the 4th week of intra-uterine life. (b) The developing tongue at the 5th month. Numbers 1-4 indicate the positions of the pharyngeal (______________) arches. Four swellings are seen: two ________ _______ _____ (lateral lingual swellings; A), the _______ _______ ____ (tuberculum impar; B) and the hypopharyngeal eminence

Branchial, distal tongue buds, median tongue bud

Brucella melitensis, Brucella suis, Brucella abortus What bacteira (3)

Brucellosis

influences the structure of the bone and teeth enamel What mineral?

FLouride

_____________ diffusion is catalyzed by transporters that permit the movement of ions and molecules down concentration gradients, whereas uphill or active transport requires energy.

Facilitated

Histoplasmosis Caused by what type of pathogen?

Facultative intracellualr fungi

Deficiency of ____: Peripheral blood film shows Heinz bodies in red blood cells and a single reticulocyte. (Supravital new methylene blue stain.)

G6PD

The search during World War II for a substitute quinine led to the use of newer antimalarial drugs and the discovery of deficiency of ____, an enzyme that helps the RBC to turn carbohydrates into energy.

G6PD

D glucose Kt = 1.8* Glucose Ubiquitous Which glucose transporter?

GLUT 3

D glucose Kt = 5 Glucose Skeletal and cardiac muscles, adipose tissues Which glucose transporter?

GLUT 4

D glucose Kt = 6-11** Fructose Intestine Which glucose transporter?

GLUT 5

Oxidized glutathione AKA

GSSG

Aplastic anemia: In long-term survivors, however, the development of chronic graft-versus-host disease (____) is not uncommon

GVHD

Chronic graft vs host diseaase AKA

GVHD

not a distinctive pattern of cell death, the term is still commonly used in clinical practice. It usually refers to the condition of a limb, generally the lower leg, that has lost its blood supply and has undergone coagulative necrosis involving multiple tissue layers. When bacterial infection is superimposed, coagulative necrosis is modified by the liquefactive action of the bacteria and the attracted leukocytes

Gangrenous necrosis

When _ ___________ is converting to the yeast phase at 37°C, the heat shock response is induced, oxidative phosphorylation is uncoupled, and RNA and protein synthesis is stopped.

H capsulatum

Wild-type _ ___________ with cell walls that contain α-(1,3)-glucan not only survive within macrophages but also undergo cell division, eventually killing the host cell

H capsulatum

_ __________ prevents the acidification of phagolysosomes in alveolar macrophages, thereby inhibiting degradative enzymes.

H capsulatum

_ ____________ prevents the acidification of phagolysosomes in alveolar macrophages, thereby interfering with enzymatic digestion and antigen processing and helping the survival of the fungus

H capsulatum

Stomach (parietal cell in gastric gland) H+ and K+ Acidification of stomach lumen Which primary active transporter?

H+ K+ ATPase

The carrier-type ionophores, nigericin and monensin, exchange __ for ___ and __, respectively. Ionomycin and A23187 are Ca2+ ionophores.

H+, Na+, K+

The head-to-head dimer of gramicidin A makes a transmembrane channel that allows movement of monovalent cations (__, ___, __)

H+, Na+, K+

__-blockers (receptor antagonists) such as cimetidine and ranitidine indirectly inhibit acid secretion by competing with histamine for its receptor

H2

Highly Active Antiretroviral Therapy AKA

HAART

Highly Active Antiretroviral Threapy AKA

HAART

Histone Deacetylase AKA

HDAC

In the classic form of hemochromatosis, the mutated gene encodes the protein known as hereditary hemochromatosis protein (___), which is structurally similar to _____ _ _____ __________________ antigens

HFE, Class I Major Histocompabitility

Human Herpesvirus 8 AKA

HHV-8

Prevention of HIV: ____________ the population as to how HIV is transmitted and explaining __________ measures, such as the practicing of safe sex, the proper use of condoms, monogamous relationships, and not sharing or reusing needles.

Educating, prevention

Infections of the keratinized skin, hair, and nails by fungi are classified as cutaneous mycoses and are caused by dermatophytes, which include the genera _______________, _____________, and _____________.

Epidermophyton, Trichophyton, Microsporum

H+-ATPase Mitochondrial inner membrane H+ ATP synthesis driven by electrochemical gradient of H+ Which primary active transporter?

F ATPase

As discussed in detail in the next chapter, the mitochondrial _-______ works in the backward direction, synthesizing ATP from ADP and phosphate as protons move _____ an electrochemical (concentration and charge) gradient generated across the inner mitochondrial membrane during oxidative metabolism.

F ATPase, down

Coupling factor ATPases (_-________) in mitochondrial, chloroplast, and bacterial membranes hydrolyze ATP and transport __________ ions (__)

F ATPases, hydrogen, H+

Which of the following facilitates breakdown of the nuclear envelope during the onset of mitosis? a. Disassembly of nucleosomes in the associated constitutive heterochromatin b. Increased export of material by the nuclear pore complexes into the perinuclear space c. Phosphorylation of lamin subunits by a cyclin-dependent kinase (CDK) d. Activities triggered at a restriction point late in G1 e. The activity of proteasomes

C

White adipocytes are derived developmentally from what precursor cells? a. Monocytes b. Fibroblasts c. Mesenchymal cells d. Brown adipocytes e. Mast cells

C

Cytomegalovirus AKA

CMV

Carbon Monoxide AKA

CO

How does CO posoioning happen?

CO forms a stable complex with hemoglobin that prevents oxygen binding.

Oral herpes AKA

COld sore

Cerebrospinal fluid AKA

CSF

Cytotoxic T LYmphocytes AKA

CTLs

Cytotoxic T Lymphocytes AKA

CTLs

Increased cytosolic ____ activates a number of enzymes, with potentially deleterious cellular effects

Ca2+

Increased intracellular ____ levels may also induce apoptosis, by direct activation of caspases and by increasing mitochondrial permeability.

Ca2+

Ischemia and certain toxins cause an increase in cytosolic calcium concentration, initially because of release of ____ from the intracellular stores, and later resulting from increased influx across the plasma membrane.

Ca2+

Plasma membrane Ca2+ Ca2+ excretion to outside of the cell Which primary active transporter?

Ca2+ ATPase

Sarcoplasmic reticulum and endoplasmic reticulum Ca2+ Ca2+ sequestration into sarcoplasmic (endoplasmic) reticulum Which primary active transporter?

Ca2+ ATPase

Mutations of P-ATPase genes cause Brody cardiomyopathy (____-_______), familial hemiplegic migraine type 2 (___/__ __________), and Menkes and Wilson's diseases (____ ___________).

Ca2+ ATPase, Na+ K+ ATPase, Cu2+ ATPase

Muscle Contraction: A ____-______ in the sarcoplasmic reticulum then hydrolyzes ATP to transport Ca2+ back out of the cytoplasm into the lumen of the sarcoplasmic reticulum, _____________ the cytoplasmic Ca2+ and allowing the muscle to relax

Ca2+ ATPase, decreasing

Phenylalkylamine (verapamil), benzothiazepine (diltiazem), and dihydropyridine (DHP; nifedipine) are ____-_______ _________ that inhibit VDCCs

Ca2+ channel blockers

Ryanodine is a potent inhibitor of the ____ ________ in the ___________ ____________

Ca2+ channel, sarcoplasmic reticulum

The importance of ____ in cell injury was established by the experimental finding that depleting extracellular ____ delays cell death after hypoxia and exposure to some toxins

Ca2+, Ca2+

Dystrophic calcification: After initiation in either location, propagation of crystal formation occurs. This is dependent on the concentration of ____ and ______ the presence of mineral inhibitors, and the degree of collagenization, which enhances the rate of crystal growth.

Ca2+, PO4-

In the final stages of the absorption process, the IF molecule binds to the ileal receptor in the presence of ____ and at _______ pH. As the IF-B12 complex crosses the ileal mucosa, IF is released and the B12 is transferred to a plasma transport protein ____

Ca2+, neutral

Ryanodine inhibits the ____ -release channel in the ____________ ____________

Ca2+, sarcoplasmic reticulum

In cardiac muscle, VDCCs permit the entry of a small amount of ____, which then stimulates Ca2+ release through the Ca2+ channel from the lumen of the ____________ __________ (____-induced _____ release)

Ca2+, sarcoplasmic reticulum, Ca2+, Ca2+

Rickets is due to _______ defeciency

Calcium

essential for bone metabolism, and for secretory processes and cellular signaling What minerals (2)

Calcium Phosphate

Some of the internal components of the cell wall, such as β-glucans, can be exposed on the cell surface in some locations (eg, the bud scar in ________ ________).

Candida albicans

Opportunistic mycoses are seen in immunosuppressed or debilitated individuals, or those with catheters, and are caused by normally commensal fungi, including ______ and ___________

Candida, Aspergillis

Oral lesion most likely seen in seropositive, but not separated into stages of HIV? Least likely?

Candidiasis HIV periodontitis

Oral lesion most likely seen in ARC patients? Least likely? (3)

Candidiasis Kaposi Sarcoma, Venereal warts, NUG

Oral lesion most likely seen in seronegative but high risk group of HIV? Least likely? (2)

Candidiasis Kaposi sarcoma, HIV related periodontitis

Oral lesion most likely seen in HIV patient? Least likely?

Candidiasis Venereal warts

___-soluble vitamins: A, D, E, K

FAT

Prevention of HIV: _________-control measures, including universal precautions based on the assumption that all patients are infectious for HIV. These include wearing protective gloves, mask and gown, and other barriers to prevent exposure to blood products. Contaminated surfaces should be disinfected with 10% household bleach, 70% ethanol or iso-propanol, 2% glutaraldehyde, and 4% formaldehyde (or _% ________ __________).

Infection, 6 hydrogen peroxide

Inhibitors of vitamin _ action are valuable antithrombotic drugs

K

Premature infants are especially at risk of deficiency and may develop the hemorrhagic disease of the newborn What vitamin?

K

Vitamin _ deficiency causes bleeding disorders

K

Vitamin _ is necessary for blood clotting

K

Vitamin _ is required for post-translational modification of coagulation factors (factors II, VII, IX, and X)

K

Feces in diarrhea has high __ compared to ECF

K+

Maiin intracellular cation

K+

ICF: Highest cation concentration? Anions (2)

K+ Proteins, pohsophate

In the ICF, the main cation is __, present in a concentration of about ___ mmol/L. This is almost 30-fold greater than its concentration in the ECF and in plasma (_ mmol/L).

K+, 110, 4

__ binds in the central core of valinomycin, and the complex diffuses across the membrane, releasing the __, gradually dissipating the __ gradient.

K+, K+, K+

Specific inhibitors of vitamin _-dependent _____________ are used in the treatment of __________-related diseases, e.g. in patients with deep vein thrombosis and pulmonary thromboembolism, or those with atrial fibrillation who are at risk of thrombosis.

K, carboxylation, thrombosis

form of vitamin K in plants

K1

Vitamin K circulates as phylloquinone (vitamin __) and its hepatic stores are in the form of manaquinones (vitamin __).

K1, K2

Form of vitamin K in animals

K2

Stage 2 HIV AKA (2)

Latent Period Asymptomatic stage

Distal tongue buds AKA

Lateral lingual swellings AKA

Legionnaires disease What bacteira?

Legionella spp. (Legionella pneumophila)

_______ is a polypeptide hormone with target cells in the hypothalamus that is released from white adipocytes and helps regulate eating behavior.

Leptin

White blood cells AKA

Leukocytes

does not respond to improved plaque control procedures. Condition is associated with candidiasis. Which oral HIV condition?

Linear Gingival Erythema

usually responds to plaque removal, improved oral hygiene, and chlorhexidine rinses. Persistent cases usually respond to local measures plus systemic antifungal medications. Therapy for NUG, NUP, and NS involves debridement (removal of necrotic tissue and povidone-iodine irrigation), chlorhexidine rinses, metronidazole, follow-up care, and long-term maintenance. Which periodontal HIV condition?

Linear Gingival Erythema

In this patient, the ________ ______ extends across the floor of the mouth to become attached to the ________ _____________ behind the ____________ ________, giving an ankyloglossia.

Lingual frenum, lingual alveolus, mandibular incisors

These include unesterified free fatty acids, acyl carnitine, and lysophospholipids, all of which accumulate in injured cells as a result of phospholipid degradation. These catabolic products have a detergent effect on membranes. They may also either insert into the lipid bilayer of the membrane or exchange with membrane phospholipids, causing changes in permeability and electrophysiologic alterations. What compound?

Lipid breakdown products

____________ granules in a cardiac myocyte. A, Light microscopy (deposits indicated by arrows). B, Electron microscopy. Note the perinuclear, intralysosomal location.

Lipofuschin

_____________, or "wear-and-tear pigment," is an insoluble brownish-yellow granular intracellular material that accumulates in a variety of tissues (particularly the ______, ______, and _______) as a function of age or atrophy. _______________ represents complexes of lipid and protein that derive from the free radical-catalyzed peroxidation of polyunsaturated lipids of subcellular membranes. It is not injurious to the cell but is a marker of past free radical injury. The brown pigment, when present in large amounts, imparts an appearance to the tissue that is called _____ ________. By electron microscopy, the pigment appears as perinuclear electron-dense granules

Lipofuschin, brain, heart, liver, lipofuschin

____________ necrosis. An infarct in the brain showing dissolution of the tissue.

Liquefactive

seen in focal bacterial or, occasionally, fungal infections, because microbes stimulate the accumulation of inflammatory cells and the enzymes of leukocytes digest ("liquefy") the tissue. For obscure reasons, hypoxic death of cells within the central nervous system often evokes liquefactive necrosis. Whatever the pathogenesis, the dead cells are completely digested, transforming the tissue into a liquid viscous mass. Eventually, the digested tissue is removed by phagocytes. If the process was initiated by acute inflammation, as in a bacterial infection, the material is frequently creamy yellow and is called pus

Liquefactive necrosis

Vitamin A is stored where?

Liver

a condition characterized by a non-papillated, reddish region in the anterior two-thirds of the tongue in front of the sulcus terminalis and in the midline

Median rhomboid glossitis

_____________ anemia characteristic of vitamin B12 deficiency is probably due to a secondary deficiency of reduced folate, and a consequence of the accumulation of N5-methyltetrahydrofolate.

Megaloblastic

__________ is an endogenous, brown-black pigment that is synthesized by melanocytes located in the epidermis and acts as a screen against harmful ultraviolet radiation. Although melanocytes are the only source of melanin, adjacent basal keratinocytes in the skin can accumulate the pigment (e.g., in ___________), as can dermal macrophages.

Melanin, frekcles

________ ________ are required for transport of larger molecules across biomembranes

Membrane proteins

Neiserria meiningitids AKA

Meningococcus

X-linked _______ ________ is a lethal disorder that occurs in 1 in 100,000 newborn infants and is characterized by abnormal and hypopigmented hair, a characteristic facies, cerebral degeneration, connective tissue and vascular defects, and death by the age of 3 years

Menkes disease

The kinetics of facilitated diffusion for substrates can be described by the same equations that are used for enzyme catalysis (e.g. ________-______ and __________-____type equations) where the __ is the concentration that gives the half-maximal transport rate. The Kt for a transporter is conceptually the same as the __ for an enzyme

Michelis Mentin, Lineweaver Burke, Kt, Km

What prevents vitamin K defeciency in man?

Microflora

The provirus may stay dormant or enter a productive cycle. In the latter case, the viral genome is transcribed into a full-length RNA by the ___ ___________ __ of the host cell.

RNA polymerase II

The ionic balance of renal epithelial cells is regulated by the renal outer medullary K+ channel (____) and the Cl- channel (___).

ROMK, ClC

Reactive Oxygen Species AKA

ROS

The generation, removal, and role of reactive oxygen species (___) in cell injury. The production of ROS is increased by many injurious stimuli. These free radicals are removed by spontaneous decay and by specialized enzymatic systems. Excessive production or inadequate removal leads to accumulation of free radicals in cells, which may damage lipids (by _______________), proteins, and deoxyribonucleic acid (___), resulting in cell injury.

ROS, peroxidation, DNA

Reverse Transcriptase AKA

RT

HIV: The polymerase, pol, gene encodes __ ____________, and _________.

RT integrase, protease

Anti-HIV-1 drugs include __ inhibitors dideoxycytidine and dideoxyinosine, the __-__________ antagonist maraviroc, the _______ inhibitor enfuvirtide, the __________ inhibitor raltegravir, and the _________ inhibitors saquinavir and darunavir.

RT, co receptor, fusion, integrase, protease

Germen measels AKA

RUBELLA

___-type receptors can also interact with other nuclear receptors such as those for vitamin D3, thyroid hormones or peroxisome proliferator-activated receptors (PPARs).

RXR

The retinoid acid receptors (RARs) bind all-trans- and 9-cis-retinoic acid, while the so-called rexinoid receptors (____) bind the _-___ isomer only.

RXRs, 9 cis

HIV nucleic acid: positive p24 antigen; positive DNA PCR assay; ELISA and Western blot may or may not be positive. Which stage of HIV?

Recent infection

Patient is unaware of his or her HIV infection. Can transmit the infection by blood or sexual activity. Which stage of HIV?

Recent infection

RBCs AKA

Red blood cells

Apoptosis: Change in cell size? Nucleus changes? Plasma membrane changes? Cellular contents? Adjacent inflammation? Pathologic or physiologic?

Reduced Fragmented into nucleosome sized fragments Intact; altered structure, espeically orientation of lipids Intact, may be relased into apoptotic bodies No Often physiologic; means of eliminating unwanted cells; may be pathologic after some forms of cell injjry, especially DNA and protein damage.

Laboratory confirmation of HIV infection and CD4+ T lymphocyte count is <200 cells/µL or CD4+ T lymphocyte percentage of total lymphocytes is <14 or documentation of an AIDS-defining condition (see Box 18-1). Documentation of an AIDS-defining condition supersedes a CD4+ T lymphocyte count of ≥200 cells/µL and a CD4+ T lymphocyte percentage of total lymphocytes of ≥14. Which CDC stage of HIV?

Stage 3

Opportunistic infection(s): Pneumocystis jiroveci pneumonia Cryptococcosis Tuberculosis Toxoplasmosis Histoplasmosis Others Malignancies: Kaposi sarcoma Burkitt's lymphoma Non-Hodgkin's lymphoma Primary CNS lymphoma Invasive cervical cancer, carcinoma of rectum Slim (wasting) disease Which stage of HIV?

Stage 3

Dental treatment of the HIV-infected patient without symptoms is no different from that provided for any other patient in the practice. _______ ____________ must be used for all patients

Standard precautions

Childhood gastroenteritis What virus?

Rotavirus

German measles (rubella) What virus?

Rubella virus

Measels AKA

Rubeola

marked accumulation of newly synthesized immunoglobulins that may occur in the RER of some plasma cells, forming rounded, eosinophilic things called _________ ________

Russell bodies

_. _______ and __________ __________ destroy alveolar walls and form abscesses that heal with scar formation.

S aureus, Klebesiella pneumoniae

_. __________ usually spares alveolar walls in the lung, and even lobar streptococcal pneumonias typically resolve completely without permanent damage

S pneumoniae

Children should receive vaccination against _. _____________, _. _______________, hepatitis _, and ____________.

S. pneumoniae, H. influenzae, B, influenza

Pharyngitis, erysipelas, scarlet fever What bacteria?

S. pyogenes

The electrochemical gradient is a source of energy for transport of many substances such as the co-transport of the sodium ions with glucose (the ____), amino acids, and phosphate.

SGLT

D glucose Kt = 0.35 Glucose (2Na+/1 glucose), galactose Intestine, kidney Which glucose transporter?

SGLT 1

Glucose transport from intestinal lumen into the blood. Glucose is pumped into the cell through the Na+-coupled glucose symporter (_____), and passes out of the cell by facilitated diffusion mediated by the _____-_ uniporter. The Na+ gradient for glucose symport is maintained by the Na+/K+-ATPase, which keeps the intracellular concentration of Na+ low. _________ is inhibited by phlorizin and ____-_ by phloretin. Phloretin-insensitive ____-_ catalyzes the uptake of fructose by facilitated diffusion. The fructose is then exported through ____-_. A defect of _____ causes glucose/galactose malabsorption. Adjacent cells are connected by impermeable tight junctions, which prevent solutes from crossing the epithelium.

SGLT1, GLUT 2, SGLT1, GLUT 2, GLUT 5, GLUT 2, SGLT1

Superoxide dismutases AKA

SODs

gp120 AKA

SU

HIV: The highly glycosylated surface protein (__) _____ binds to the host cell surface receptor CD4, which is found on helper T lymphocytes, monocytes, and macrophages.

SU, gp120

The replication cycle of HIV-1 begins with binding of the viral envelope surface glycoprotein (__) _____ to ___ and to a secondary receptor, which is normally a __________ receptor.

SU, gp120, CD4, chemokine

To evaluate the potential to mutate DNA, the American biochemist Bruce Ames developed a simple test, using special ___________ _________ strains that cannot grow in the absence of __________ (____ phenotype).

Salmonella typherium, histidine, His-

Typhoid fever bacteria?

Salmonella typhi

Staph enterotoxin that can be a agent of bioterrorism?

Staph enterotoxin B

__________ (or ____________) live on dead or decaying organic matter.

Saprobes, saprophytes

Anemia, leukopenia Midazolam Which HIV drug? Which class?

Saquinavir Protease inhibitor

_______________ and ____________ are important characteristics of membrane transport systems

Saturability, specificity

Abscess, cellulitis, pneumonia, sepsis What bacteria (2)

Staphylococcus aureus, Staphylococcus epidermidis

____________ ______________ infection of the bladder with numerous calcified eggs and extensive scarring.

Schistosoma haebitum

Prevention of HIV: _________ blood, blood products, and organs for HIV

Screening

__________ ______ transport uses electrochemical gradients of Na+ and H+, or membrane potential

Secondary active

HIV antibody-negative at start of syndrome. Seroconversion occurs near end of the syndrome. CD4+ and CD8+ lymphocytes reduced in numbers, but >500 cells/µL After acute symptoms, they tend to return toward normal levels. ELISA and Western blot are positive. Which stage of HIV?

Stage 1

Laboratory confirmation of HIV infection, no AIDS-defining conditions and CD4+ T lymphocyte count of ≥500 cells/µL or CD4+ T lymphocyte percentage of total lymphocytes of ≥29. Which CDC stage of HIV?

Stage 1

Symptoms occur within about 1-3 weeks after infection in about 70% of infected patients: Fever, weakness, diarrhea, nausea, vomiting, myalgia, headache Weight loss Pharyngitis Skin rashes (roseola-like or urticarial) Lymphadenopathy Symptoms clear in about 1 to 2 wk Which stage of HIV?

Stage 1

The severity of the acute syndrome varies among infected persons. The period for seroconversion of 30% of patients without acute symptoms varies and can be 1-6 months or longer. Which stage of HIV?

Stage 1

ELISA and Western blot are positive. A slow but usually steady increase in viral load. Usually, a steady decline in CD4+ cell count; CD4+/CD8+ ratio begins to approach 1. which stage of HIV?

Stage 2

caused by a poxvirus. The lesions are small papules with a central depressed crater. In immunocompetent persons, the lesions are self-limiting and are found on the genitals and trunk. In patients with AIDS, multiple lesions (hundreds) are found that do not regress (5% to 10% of patients with lesions have lesions of the facial skin) Which oral HIV condition?

Molluscum Contagiosum

How to identify cryptococci?

Mucicarmine

Meningeal blood vessels with angioinvasive _____ species. Note the irregular width and near right-angle branching of the hyphae.

Mucorr

Mumps, pancreatitis, orchitis What virus?

Mumps virus

The promoter region of DNA contains a ____ sequence, an easily melted region of DNA that facilitates the unwinding of DNA during the early stages of gene expression

TATA

TATA sequence AKA

TATA box

Delivers B12 to the CNS

TCII

ELISA and Western blot are positive. HIV antigen, RNA, and DNA tests are positive. Signs and symptoms increase as CD4+ cell count declines and approaches 200/µL; often between 200 and 300/µL. Viral load continues to increase. Platelet count may decrease in about 10% of patients. Which stage of HIV?

Stage 2

Laboratory confirmation of HIV infection, no AIDS-defining condition, and laboratory confirmation of HIV infection and CD4+ T lymphocyte count of 200-499 cells/µL or CD4+ T lymphocyte percentage of total lymphocytes of 14-28. Which CDC stage of HIV?

Stage 2

Median time from initial infection to onset of clinical symptoms: 8-10 years About 50-70% of patients develop persistent generalized lymphadenopathy (PGL). Which stage of HIV?

Stage 2

The spectrum of disease changes as CD4+ cell count declines. Which stage of HIV?

Stage 2

Viral replication is ongoing and progressive. A steady decline in CD4+ cell counts occurs, except in the less than 1% who are nonprogressors (also have low viral load). Which stage of HIV?

Stage 2

*Disseminated Mycobacterium tuberculosis •Mycobacterium avium-intracellulare complex infections What type of opportunistic infections in AIDS patients?

Mycobacterial

Leprosy What bacteria?

Mycobacterium leprae

Mycobacterial opportunistic infections in AIDS patients: *Disseminated _____________ ____________ •______________ _____-_______________ complex infections

Mycobacterium tubecylosis Muycobacterium avium intracellulaire

Antigenic stimulation of the immune system in the form of antigen presentation to __ cells can result in the generation of Th1 cells that secrete interleukin-2 (IL-2) and interferon gamma (IFN-γ) or Th2 cells that generate IL-4, IL-5, and IL-10

Th

HIV: The main bacterial opportunistic infections are caused by ____________ _____________, _____________ _____-_______________ complex, and the gastrointestinal pathogens ________, ________, and _____________.

Mycobacterium tuberculosis, Mycobacterium avium intracellulaire, Salmonella, Shigella, Campylobacter

Activation of naïve Τ cells along the ___ pathway results in the production of IFN-γ, IL-2, IL-12, and IL-18 that stimulate phagocytosis and the production of cytotoxic CD8+ T cells and opsonizing antibodies, resulting in a protective effect against fungal infections.

Th1

Activation of the ___ pathway stimulates phagocytosis and the production of cytotoxic CD8+ T cells and opsonizing antibodies, resulting in a protective effect against fungal infections.

Th1

Humoral immune responses to C neoformans can help resolve the infection, although ___ responses appear to be more important in this process.

Th1

Antigenic stimulation of the immune system in the form of antigen presentation to Th cells can result in the generation of ___ cells that secrete interleukin-2 (IL-2) and interferon gamma (IFN-γ) or ___ cells that generate IL-4, IL-5, and IL-10

Th1, Th2

C immitis antigens may elicit a strong ___ response, thereby directing the immune response away from the ___ response that would have been able to resolve the infection, as deducedfrom animal experiments.

Th2, Th1

In experimental animals, generation of a ___ response is not protective against B dermatitidis infection, whereas a ___ response limits the spread of the infection and enables antifungal therapy to clear the infection.

Th2, Th1

Problems with devices in HIV patients?

NOne

Nucleoside analog reverse transcriptase inhibitors AKA

NRTIs

Necrotizing Stomatitis AKA

NS

Necrotizing Ulcerative Gingivitis AKA

NUG

Necrotizing Ulcerative Periodontitis AKA

NUP

During muscle contraction, nerves at the neuromuscular junction stimulate local depolarization of the membrane by opening voltage-dependent ___channels.

Na+

Inhibition of ___ channels represses transmission of the depolarization signal.

Na+

Sweat has low ___ compared to ECF

Na+

several ___ transport proteins participate in Na+ reabsorption in the kidney tubules

Na+

Not only the sarcoplasmic reticulum Ca2+-ATPase but also an ____/___-______________ and a plasma membrane ____ _______ are responsible for pumping out cytoplasmic Ca2+ from heart muscle

Na+ Ca2+ antiporter, Ca2+ ATPase

A ___/__ ______ drives uptake of glucose into intestinal and renal epithelial cells

Na+ K+ ATPase

As in intestinal epithelial cells, the low intracellular concentration of Na+ is maintained by an ___/__ ______ on the opposite side of the tubular epithelial cell, which antiports three cytoplasmic sodium ions for two extracellular potassium ions, coupled with hydrolysis of a molecule of ATP.

Na+ K+ ATPase

Plasma membranes (ubiquitous, but abundant in kidney and heart) Na+ and K+ Generation of electrochemical gradient of Na+ and K+ Which primary active transporter?

Na+ K+ ATPase

The ___/__ ______ is electrogenic, pumping out three Na+ and pumping in two K+ ions, generating an inside-negative membrane potential.

Na+ K+ ATPase

The desirable level of systolic blood pressure is below ___ mmHg and diastolic pressure __ mmHG (optimal values are still lower, below ___/__ mmHg).

The desirable level of systolic blood pressure is below ___ mmHg and diastolic pressure __ mmHG (optimal values are still lower, below ___/__ mmHg).

cardiac glycosides such as ouabain and digoxin increase heart muscle contraction and are used for treatment of congestive heart failure. They act by inhibiting the ___/__ _________ that generates the ___ concentration gradient used to drive export of ____ by the ___/____ _____________

Na+ K+ ATPase, Na+, Ca2+, Na+, Ca2+ antiporter

Lidocaine, a ___-_________ _________, is used as a local anesthetic and antiarrhythmic drug.

Na+ channel blocker

Angiotensin II also promotes elevations in blood pressure by direct vasoconstriction and by increasing ___ _______________ in the ________ ________

Na+ reabsorption, proximal tubule

Primary active transport systems use ATP directly to drive transport; secondary active transport uses an electrochemical gradient of ___ or __ ions, or a membrane potential produced by primary active transport processes.

Na+, H+

Primary active transport systems use ___ directly to drive transport; secondary active transport uses an electrochemical gradient of ___ or __ ions, or a membrane potential produced by primary active transport processes

Na+, H+

Without treatment, lasts for 1 to 3 years. Any of the following: PGL Fungal infections Vaginal yeast and trichomonal infections Oral hairy leukoplakia Herpes zoster Herpes simplex HIV retinopathy Constitutional symptoms: fever, night sweats, fatigue diarrhea, weight loss, weakness Which stage of HIV?

Stage 2

_____________ are the building-blocks of chromatin

Nucleosomes

Mechanisms of membrane damage in cell injury. Decreased __ and increased cytosolic ____ typically are seen in ischemia but may accompany other forms of cell injury. ___, which often are produced on reperfusion of ischemic tissues, also cause membrane damage

O2, Ca2+, ROS

Oral Hairy Leukoplakia AKA

OHL

Origin Recognition Complex AKA

ORC

Trachoma, urethritis Casued by what type of pathogen?

Obligate intracellualar bacteria

Chlamydia trachomatis What type of pthogen?

Obligate intracellualr bacteria

Kala-azar What type of pathogen?

Obligate intracellular protazoa

Leishmania donovani What type of pathogen?

Obligate intracellular protazoa

the lagging strand is synthesized in small fragments, 1000-5000 base pairs in length, termed _______ _________

Okazaki fragments

The three human retrovirus subfamilies are the ____________, which includes human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2; the ____________, which includes HIV-1 and HIV-2; and the ____________.

Oncovirinae, Lentivirinae, Spumavirinae

_______________ mycoses are seen in immunosuppressed or debilitated individuals, or those with catheters, and are caused by normally commensal fungi, including Candida and Aspergillis

Opportunistic

Nystatin often is ineffective. Topical clotrimazole is effective but has high rate of recurrence. Systemic fluconazole and itraconazole are effective but have a number of drug interactions and may result in drug-resistant infection. If azoles fail, then intravenous amphotericin B can be administered. What oral HIV condition?

Oral Candidiasis

Treatment often is not needed. Acyclovir or desiclovir can result in rapid resolution, but recurrence is likely. Retinoids or podophyllum resin therapy can lead to temporary remission. HIV therapy with ART can result in significant regression. Which HIV periodontal condition?

Oral Hairy Leukoplakia

White lesion most often found on the lateral border of the tongue. It on rare occasions has been found on the buccal mucosa, soft palate, and pharynx. Associated with Epstein-Barr virus infection. In an untreated patient with HIV symptomatic infection, the finding of this indicates that AIDS will develop in the near future. Which HIV periodontal condition?

Oral Hairy Leukoplakia

Most common intraoral manifestation of HIV infection. First found during the early symptomatic stage of infection. This indicates that AIDS will develop within 2 years in untreated patients. About 90% of patients with AIDS will develop oral infection at some time during their disease course. What oral HIV condition?

Oral candidiasis

Drugs that can cause B6 defeciency (2)

Oral contraacepives Isonazid

Can be found in the oral cavity, pharynx, and larynx in HIV-infected persons. The same risk factors apply as for the general population, but the cancer occurs at a younger age (it appears that HIV infection accelerates onset). Which oral HIV condition?

Oral squamous cell carcinoma

Treatment of the disease is the same as for non-HIV-infected patients: surgery, irradiation, chemotherapy, or combination therapy. Which condition of oral HIV?

Oral squamous cell carcinoma

Anterior 2/3 of tongue AKA

Oral tongue

_________ damage is probably the most common form of DNA damage; it is increased in inflammation, by smoking, in aging and in age-related diseases, including atherosclerosis, diabetes and neurodegenerative diseases

Oxidative

Respiratory burst AKA

Oxidative Burst

Accumulation of Oxygen Derived Free Radicals AKA

Oxidative Stress

______ demand serves as the stimulus for erythropoiesis.

Oxygen

A _ _______ in gastric parietal cells maintains the low pH of the stomach

P ATPase

_-_________ form phosphorylated intermediates that drive ion translocation: the '_' refers to the _______________.

P ATPases, P phosphorlyation

Mammalian estrogen binds to proteins of _ ____________ and blocks the transition from the saprophytic form of the fungus to the invasive form.

P brasilinesis

The observation that the rate of symptomatic disease caused by _ _______________ is 78 times greater in males than in females has led to the hypothesis that hormones are important in the pathogenesis of this fungus.

P brasilinesis

In _ _____________, the β-(1,3)-glucan induces an intense inflammatory response, and the gp43 protein elicits a strong humoral as well as a delayed-type hypersensitivity response.

P brasilinessis

_-type Na+/K+-ATPase in various tissues and the ____-________ in the sarcoplasmic reticulum have important roles in maintaining cellular ion gradients.

P, Ca2+ ATPase

Plasma membrane Various drugs Excretion of harmful substances, multidrug resistance for anticancer drugs Which primary active transporter?

P-glycoprotein

Nucleic acid amplification using polymerase chain reaction (___)-based assays of the viral RNA is performed to determine the viral load in the blood (i.e., degree of _______) and monitor response to therapy.

PCR, viremia

Where is vitamin C reabsorbed in the kidney?

PCT

Prostaglanding E2 AKA

PGE2

persistent Generalized Lymphadenopathy AKA

PGL

Persistent Hyperinsulinemic Hypoglycemia of Infancy AKA

PHHI

Persistent Hyperinsulinemic hypoglycemia of Infancy AKA

PHHI

Protease inhibitor AKA

PI

Protease Inhibitors AKA

PIs

_________ of the hand in anemia is obvious in this patient, especially when compared with the physician's hand on the right. The patient's hemoglobin was 7 g/dL. The patient's hand also shows that he was a heavy smoker. The cause of the anemia was chronic blood loss from ___________ of the _____________.

Pallor, carcinoma, esophagus

Some patients with iron deficiency anemia develop _______ ______ ________, which is characterized by a sore mouth, dysphagia (resulting from muscular degeneration in the esophagus with esophageal stenosis or "webbing"), and an increased frequency of carcinoma of the oral cavity and pharynx.

Plummer Vinson Syndrome

Feature of ______-______ _______. Barium contrast radiograph demonstrates esophageal webbing.

Plummer Vinson syndrome

One of the first opportunistic infections recognized early in the HIV epidemic was Pneumocystis carinii pneumonia. The organism has been recently renamed ____________ __________

Pneumocystic jirovecii

Chemoprophylaxis regimens exist for the prevention of ____________ pneumonia, tuberculosis, toxoplasmosis, and other opportunistic diseases

Pneumocystis

One of the first opportunistic infections recognized early in the HIV epidemic was ___________ ______ pneumonia

Pneumocystis carnii

Fungi opportunistic infectios in AIDS patients: •___________ ___________ pneumonia •Cryptococcosis •Candidiasis •Disseminated histoplasmosis •Disseminated coccidioidomycosis

Pneumocystis jirovecii

Streptococcus pneumoniae disease (2)

Pneumonia Meningitis

Poliomyelitis What virus?

Poliovirus

Genetic variations AKA

Polymorphisms

HIV: ____________ ___________, for example following a needlestick injury, is essential to prevent infection.

Postexposure prophylaxis

Atrophy: _______ __________ decreases because of reduced metabolic activity.

Protein synthesis

•Toxoplasmosis •Cryptosporidiosis •Isospora belli infection •Entamoeba histolytica infection What type of opportunistic infections in AIDS patients?

Protozoan

____________ may form when daughter yeast cells elongate.

Pseudohyphae

Types of oral candidiasis (4)

Pseudomembranous Erythematous Hyperplastic Angular cheilitis

Chlamydia psittaci what bioterrorism agent?

Pstiacitosis

Rough ER AKA

RER

Ribonucleic Acid AKA

RNA

Ribonucleic acid AKA

RNA

Death usually occurs because of wasting, opportunistic infection, or malignancies. The use of combination antiretroviral agents has slowed the death rate, but long-term outlook must depend on vaccines for prevention and treatment because the virus promotes resistance to these agents. Which stage of HIV?

Stage 3

High viral load. CD4+ cell count below 200/ µL. CD4+ cell count below 50/µL at high risk for lymphoma and death. Platelet count may be low. Neutrophil count may be low. ELISA and Western blot are positive. HIV antigen, RNA, and DNA tests are positive. Which stage of HIV?

Stage 3

The prototypic death receptors are the ____ __ ___ receptor and ___ (____)

Type I TNF, Fas CD95

Escherichia coli,* Klebsiella pneumoniae* Urinary tract infection, wound infection, abscess, pneumonia, sepsis, shock, endocarditis Enterobacter (aerobacter) aerogenes* Proteus spp. (Proteus mirabilis, Proteus morgagni)* Serratia marcescens,* Pseudomonas spp. (Pseudomonas aeruginosa),* Bacteroides spp. (Bacteroides fragilis) These all cause what diseases (7)?

Urinary tract infection, wound infection, abscess, pneumonia, sepsis, shock, endocarditis

How is K+ lost from the body (3)

Urine Intestinal fluid in diarrhea Postoperative Surgical Drainage

Problems with equipment in Sickle cell patient

Use pulse oximeter and maintain oxygen saturation above 95%.

Cytoplasmic vesicles, such as lysosomes, endosomes, and secretory granules, are acidified by a _-____ __-_______ in their membranes

V type H+ ATPase

H+-ATPase Cytoplasmic vesicles (lysosome, secretory granules), plasma membranes (ruffled border of osteoclast, kidney epithelial cell) H+ Activation of lysosomal enzymes, accumulation of neurotransmitters, turnover of bone, acidification of urine Which primary active transporter?

V-ATPase

Phylloquiniolone AKA

Vitamin K1

Menaquinone AKA

Vitamin K2

cobalamin AKA Defeciency disease?

Vitmain B12 Pernicious anemia

Pantothenoic acid AKA

Vitmain B5

____________-dependent ____ channels (______) located in the T tubules of skeletal muscle change their conformation in response to membrane depolarization, and directly activate a ____-release channel in the sarcoplasmic reticulum membrane, a network of flattened tubules that surrounds each myofibril in the muscle cell cytoplasm.

Voltage, Ca2+ VDCCs, Ca2+

HIV: essential for virus replication in nondividing cells like macrophages and enables the viral DNA to reach the nucleus.

Vpr

In 1986, the World Health Organization (___) recommended that the AIDS virus be called the human immunodeficiency virus

WHO

Vibrio cholerae, Cryptosporidium parvum, others What type of bioterrorism agent?

Water safety threats

_____ diffuses freely across most cell membranes but the movement of ____ and _______ molecules is restricted.

Water, ions, neutral

HIV infection can be diagnosed by the presence of antibodies against viral components, using enzyme-linked immunosorbent assay (ELISA) and whole viral lysates. The results have to be confirmed using _______ ____ analysis of the presence of antibodies to particular HIV proteins.

Western blot

Beriberi associated iwth alcholism

Wet

a group of rare, life-threatening, autosomal recessive disorders (incidence = 1/250,000) that are marked by extreme sensitivity to sunlight

Xeroderma pigmentosum

Collections of neutrophils give rise to localized liquefactive necrosis, forming ________

abcesses

Primary hyperaldosteronism may be a result of a single _______ tumor, an _______ (_____ _________). The more common ________ hyperaldosteronism is due to an increased secretion of _____. _________________ are catecholamine-secreting tumors that cause _____________ in about 0.1% of hypertensive patients.

adrenal, adenoma, Conn's syndrome, secondary, renin, pheochromocytomas, hypertension

Although the metaplastic squamous epithelium has survival _______________, important _______________ mechanisms are lost, such as mucus secretion and ciliary clearance of particulate matter.

advantages, protective

progressive accumulation of metabolic damage; possible roles of growth factorsintake, loss that promote _______ in simple model organisms

aging

Proteins, particularly _______, exert osmotic pressure in the plasma (about 3.32 kPa; 25 mmHg). This is known as the _______ pressure and it retains water in the vascular bed. It is balanced by the ___________ pressure, which forces fluid in the opposite direction, i.e. out of the capillaries.

albumin, oncotic, hydrostatic

Vitamin B6 is a mixture of pyridoxine (an _______), pyridoxal (an ________), pyridoxamine, and their 5′-phosphate esters.

alchol, aldehyde

_________ abuse and ___________ associated with __________ are the most common causes of fatty change in the liver (_____ ______) in industrialized nations.

alcohol, diabetes, obesity

A deficiency in daily folate intake (as in chronic ______________) or absorption (due to _________ disease or _________ _________) of these vitamins can result in anemia.

alcoholism, celiac, tropical sprue

DNA can be damaged by numerous types of endogenous and exogenous agents that cause nucleotide modifications, deletions, insertions, sequence inversions and transpositions. Some of this damage is secondary to chemical modification of DNA by ___________ agents (including many ____________), ________ ______species and ________ radiation (__________ or ___________).

alkylating, carcinogens, reactive oxygen, ionizing, ultraviolet, radioactive

Thiamine is important for carbohydrate metabolism. In its active form, thiamine pyrophosphate (TPP), it is a coenzyme of pyruvate dehydrogenase (the E1 enzyme in the PDH complex, Chapter 14). It participates in a similar reaction of oxidative decarboxylation of _____-_____________ and also in the metabolism of ________ _____ _____ _____.

alpha ketogluterate, branched chain amino acids

Genes on chromosome 16 encode _____ globin chains; ____ chains are encoded on chromosome 11

alpha, beta

during muscle hypertrophy, the _______-myosin heavy chain is replaced by the _____ form of the myosin heavy chain, which produces slower, more energetically economical contraction.

alpha, beta

the thalassemias, another type of hemoglobinopathy, are caused by deletions or mutations of the _____ or ____ ______ gene that result in a defect in globin synthesis (reduced or absent synthesis of one or more globin chains)

alpha, beta globin

A high content of this glucan in fungus is associated with increased virulence. Name that glucan!

alpha-1,3-glucan

HIV-1 binds to the cellular adhesion molecule ______________ integrin, which is found on gut-associated lymphoid tissue, and to the __-____ receptor expressed on ___________ cells.

alpha4beta7, DC SIGN, dendritic

Pyridoxine is important for _____ ____ metabolism

amino acid

Although C immitis endospores are phagocytosed readily by alveolar macrophages, they can survive in phagosomes, producing an alkaline layer resulting from the production of ammonia or ammonium ions. It is thought that a fungal intracellular urease is involved in the production of ________

ammonia

Nausea, vomiting Amiodarone interaction PIs act at the end of the virus replication cycle, blocking the catalytic center of the protease enzyme, resulting in viral particles that are ineffective and immature. Which HIV Drug? What class?

amprenavair Protease inhibitor

Low ATP: There is a compensatory increase in __________ ___________ in an attempt to maintain the cell's energy sources. As a consequence, intracellular glycogen stores are rapidly depleted, and lactic acid accumulates, leading to decreased intracellular pH and decreased activity of many cellular enzymes.

anaerobic glycolysis

The fungal form producing asexual spores is known as an ________, and that producing sexual spores is known as a _________

anamorph, telomorph

Sickle cell _______ is the homozygous state

anemia

HIV: CD4+ T cells may be unable to respond to immune stimulation when they are "deactivated" by signals from HIV, resulting in a state known as ______

anergy

The actions of ___________ (_-_), which acts through the so-called MAS receptor (it may also bind to AT1 and AT2), also seem to be cardioprotective.

angiotensin 1 7

Angiotensin I is converted to angiotensin II by ____________ __________ ________

angiotensin converting enzyme

Renin converts _______________ into ___________ _. ___________ _ is further converted into ___________ __ by the angiotensin-converting enzyme (___). It also yields other angiotensin peptides. Cellular actions of angiotensins are mediated by ___________ _________ type _ (___), type _ (___) and ___ receptors that bind angiotensin (1-7). The renin-angiotensin system is a target for two major classes of hypotensive drugs: ___ _________ (e.g. ramipril, enalapril) and ___ ________ ___________ (e.g. losartan). ACE blockers are also extensively used in the treatment of _____ _______.

angiotensinogen, angiotensin I, angiotensin I, angiotensin II, ACE, angiotensin receptor, 1, AT1, 2, AT2, MAS, ACE blockers, AT1 receptor antagonists, heart failure

Lack of riboflavin in the diet causes a deficiency syndrome of inflammation of the corners of the mouth (_______ _________), the tongue (__________) and scaly dermatitis

angular stomatitis, glossitis

Vitamin B12 is only present in ______ products

animal

In clinical practice the rest of the anions are, for the purposes of electrolyte balance, considered together, constituting the so-called _____ ___

anion gap

The _____ ___ (in a healthy person, approximately __ mmol/L) includes phosphate, sulfate, protein, and organic anions such as lactate, citrate, pyruvate, acetoacetate, and β-hydroxybutyrate. However, it may _________ several-fold in conditions where inorganic and organic anions accumulate, e.g. in renal failure or diabetic ketoacidosis. For this reason it is clinically important.

anion gap, 10, increase

Not surprisingly, rapidly dividing cells have high requirements for folate since it is necessary for the synthesis of purines and pyrimidine thymine, all required for DNA synthesis. Structural analogues of folate exhibit selective toxicity towards rapidly growing cells such as bacteria and cancer cells. This is the principle behind the development of drugs known as the folic acid antagonists, which are used as ____________ (e.g. trimethoprim) and __________ agents (methotrexate).

antibiotics, anticancer

HIV-specific ___________ can be detected rapidly in blood or in oral fluid obtained via swabbing the gums.

antibodies

Death by __________ is a normal phenomenon that serves to eliminate cells that are no longer needed and to maintain a constant number of cells of various types in tissues.

apoptosis

When a cell is deprived of growth factors, or the cell's DNA or proteins are damaged beyond repair, typically the cell kills itself by another type of death, called _________, which is characterized by nuclear dissolution without complete loss of membrane integrity.

apoptosis

___________ eliminates cells that are genetically altered or injured beyond repair and does so without eliciting a severe host reaction, thereby keeping the extent of tissue damage to a minimum.

apoptosis

Apoptosis: The cells rapidly shrink, form cytoplasmic buds, and fragment into _________ _______ composed of membrane-bound vesicles of cytosol and organelles

apoptotic bodies

Late in apoptosis, the cell breaks into many small _________ ______ that undergo ____________ by neighboring cells.

apoptotic bodies, phagocytosis

Mutation in a water channel protein gene (_________-_) causes diuresis in patients with nephrogenic diabetes insipidus, a disease characterized by excessive urination but without the hyper-glycemia characteristic of diabetes mellitus

aquaporin 2

Ascorbic acid ionizes as what?

ascorbate

Structure and synthesis of vitamin C (________ ____). Note that the enzyme that converts gulonolactone to ascorbic acid is absent in man and higher primate.

ascorbic acid

Stem cells occur in all tissues with rapid cell turnover; they divide slowly in an ____________ manner, with one daughter cell remaining a stem cell and one becoming committed toward differentiation.

asymmetric

Dystrophic calcification is virtually inevitable in the ____________ of advanced atherosclerosis, associated with intimal injury in the aorta and large arteries and characterized by accumulation of lipids

atheromas

phagocytic cells may become overloaded with lipid (triglycerides, cholesterol, and cholesteryl esters) in several different pathologic processes. Of these, ________________ is the most important.

atherosclerosis

A family of peptides known as the natriuretic peptides are involved in the regulation of fluid volume. The two main ones are the ______ ________ _______ and the _____ _________ _______. ___ is synthesized predominantly in the cardiac atria as a 126-amino acid propeptide (___-___).

atrial naturetic peptide, brain naturetic pepdide, ANP, pro ANP

Shrinkage in the size of the cell by the loss of cell substance is known as _______

atrophy

Although the immune system defends the body against pathogenic microbes, immune reactions can also result in cell and tissue injury. Examples are ___________ reactions against one's own tissues and _________ reactions against environmental substances in genetically susceptible individuals

autoimmune, allergic

Autophagy: The vacuole fuses with lysosomes to form an __________________, in which lysosomal enzymes digest the cellular components

autophagolysosome

In many situations, atrophy is also accompanied by increased __________, with resulting increases in the number of ___________ ___________. _________ ("self-eating") is the process in which the starved cell eats its own components in an attempt to survive. We describe this process later in the chapter.

autophagy, autophagic vacuoles, autophagy

HIV gene expression is regulated by six gene products called __________ ________ or _________ ____ _________

auxillary proteins, accessory gene products

Water _______ (daily intake and loss) and water ____________ between cells and the surrounding fluid are subject to complex regulation.

balance, distribution

The digital linear code (____ ________) in the DNA double helix has a significant component that acts by altering, along its length, the shape and stiffness of the molecule.

base pairing

Multiple ____________ alterations may be triggered by any one injurious insult. It is therefore difficult to assign any one mechanism to a particular insult or clinical situation in which cell injury is prominent. For this reason, therapies that target individual mechanisms of cell injury may not be effective.

biochemical

The destruction of CD4+ T cells by HIV is caused by a number of factors, including virus ________, apoptosis, _______ _ -cell action on uninfected cells, and chronic activation.

bjudding, cytotoxic T

Yeasts reproducing by nuclear fission and by the formation of _____________ and the generation of _____________.

blastocondia, pseudohyphae

Fungi can exist as yeasts (also known as _____________) or as molds.

blastospores

Fungi can exist as yeasts (______________) or as molds. Molds are multicellular structures with tubular, elongated structures called _______. The conglomeration of hyphae results in the formation of a mycelium.

blastospores, hyphae

Cell and nuclear volumes shrink rapidly, and the cell membrane changes produce extensive ________ of the cell surface in apoptosis

blebbing

Vitamin K deficiency causes ________ disorders

bleeding

The most common initial signs and symptoms of aplastic anemia are caused by anemia and thrombocytopenia: weakness, fatigue, headaches, dyspnea with exertion, petechiae, ecchymoses, epistaxis, metrorrhagia (_________ between expected __________ __________), and gingival bleeding.

bleeding, menstrual periods

under certain circumstances, the restoration of ______ flow to __________ but viable tissues results, paradoxically, in the death of cells that are not otherwise irreversibly injured.

blood, ischemic

Patients who undergo organ (kidney, liver, bone marrow) transplantation and acquire immunosuppression develop anemia as a result of ____ ______ suppression.

bone marrow

Relapsing fever What bacteria?

borrelia recurrentis

Although P-450-mediated modification is often thought of as "detoxification," many compounds are rendered more injurious by this process; one example is ______ ________________

carbon tetrachloride

The most common exogenous pigment is _________ (an example is _____ _____), a ubiquitous air pollutant of urban life. When inhaled, it is phagocytosed by alveolar macrophages and transported through lymphatic channels to the regional tracheobronchial lymph nodes. Aggregates of the pigment blacken the draining lymph nodes and pulmonary parenchyma (_____________)

carbon, coal dust, antrhacosis

Thiamine is essential for _____________ reactions

carboxylation

Vitamin K-mediated _____________ of _________ residues. The carboxylated residues are required for ____ chelation. what enzyme does this?

carboxylation, glutamate, Ca2+ gamma-carboxylase

Measurements of natriuretic peptides help to diagnose the _______ _______

cardiac failure

anemia is an independent risk factor for adverse ________________ outcomes (i.e., acute myocardial infarction and death) in a variety of patient populations (as defined by chronic _________ disease, acute __________ syndrome, or ___ age, for example).

cardiocvascular, kidney, coronary, old

Angiotensin receptors are important in the pathogenesis of _______________ disease

cardiovascular

The mitochondrial and death receptor pathways lead to the activation of the initiator caspases, _______-_ and -_, respectively.

caspase 9, 8

Cytochrome c from mitochondria activates cytoplasmic proteases called ________, which degrade proteins of the cytosol, cytoskeleton, and cell membrane.

caspases

CTLs secrete ___________ such as RANTES, MIP-1α, and MIP-1β that bind the chemokine co-receptors for HIV, thereby restricting HIV entry and replication

chemokines

CF is usually manifested as exocrine pancreatic insufficiency, an increase in the concentration of __________ ions (___) in sweat, male infertility, and airway disease, which is the major cause of morbidity and mortality.

chloride, Cl-

The perception of taste in the anterior two-thirds of the tongue is associated with the _______ _________ nerve, a branch of the ______ nerve, the nerve of the ___ pharyngeal (branchial) arch.

chorda tympani, facial, 2nd

DNA is packaged in the _________ in a highly organized, condensed structure known as ________

chromosome, chromatin

DNA is compacted into ___________

chromosomes

__________ are compact, highly organized forms of DNA

chromosomes

Adipocytes store lipids from three sources: from dietary fats packaged as _____________ in the intestine; from triglycerides produced in the liver and circulating as ____-___-_______ _____________; and from fatty acids synthesized locally.

chylomicrons, very low density lipoproteins

Prevention of HIV infection: Use of contraceptive creams with anti-HIV drugs and male ______________. These procedures only ______ the risk of infection.

circumcision, reduce

Vitamin B6 is present in a wide variety of foods such as fish, beef, liver, poultry, and also potatoes and fruits (but not ______ fruits)

citrus

HIV: There is an extended period of ________ _______, without apparent evidence of disease.

clinical latency

However, in practice, the concentration of most ions is measured after the sampled blood has been allowed to ____ (i.e using _____).

clot, serum

All three classes of B12-transport proteins are single polypeptide chains (340-375 amino acid residues), and have a single binding site for _________

cobalamin

Vitamin B12 (_________) has a complex ring structure similar to the _________ of ____ but is hydrogenated to a greater extent.

cobalamin, porphorin, heme

Other cobalamin-binding proteins, R-proteins, secreted by the salivary glands and stomach, are also glycoproteins and along with trans-cobalamins (TC) I and III are termed _______________.

cobaliphillins

Vitamin B12. There is a cyano-group (CN) attached to the ______: this is an artifact of extraction but it is also the most stable form of the vitamin and indeed is the commercially available product. The cyano group does require removal for conversion to the active form of the vitamin.

cobalt

Vitamin B12 (cobalamin) has a complex ring structure similar to the porphyrin of heme (Chapter 30) but is hydrogenated to a greater extent. The iron at the center of the heme ring is replaced by a cobalt ion (Co3+). This is the only known function of cobalt in the body. In addition, a dimethylbenzimidazole ring is also part of the active molecule (it is essential for the chelation of the ______ ion). and in __________ synthesis

cobalt, methionine

Panthotenic acid forms part of the molecule of ________ _ (___)

coenzyme A, CoA

Apoptosis: ______ _________ (____________) pathway is responsible for elimination of self-reactive lymphocytes and damage by cytotoxic T lymphocytes; is initiated by engagement of death receptors (members of the ___ ___________ family) by ligands on adjacent cells.

death receptor extrinsic, TNF receptor

When there is water deficit (dehydration), the _________ in renal blood flow ___________ the renin-angiotensin-aldosterone system

decrease, stimulates

Water deficit (dehydration) __________ plasma volume, renal blood flow and GFR

decreases

Vitamin A deficiency presents as _________ _____ _______ or _____ _________ (it is the most common symptom of vitamin A deficiency in children and pregnant women).

defective night vision, night blindness

Abnormal intracellular accumulation: Deposition and accumulation of an abnormal exogenous substance when the cell has neither the enzymatic machinery to _________ the substance nor the ability to _____________ it to other sites. Accumulation of carbon or silica particles is an example of this type of alteration.

degrade, transport

Both deficit of body water (____________) and its excess (_____________) cause potentially serious clinical problems. Therefore, the assessment of water and electrolyte balance is an important part of clinical examination.

dehydration, overhydration

Mutations in the structure of CCR5 may prevent virus entry, as in individuals with the _______ deletion mutation

delta32

DC-SIGN AKA

dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin

Cellular nucleic acids exist in two forms, ________________ ____, and ___________ ____

deoxyribonucleic acid, ribonucleic acid

Structure of DNA. (A) A tetranucleotide sequence of DNA showing each of the nucleotides normally found in DNA. The ___________ sugars are missing the _′-________ that is present in the ______ sugars found in ____. By convention, DNA is read from the _′ to _′ end, so the sequence of this tetranucleotide is _′-GATC-_′. (B) A graphic representation of the structure of _-DNA, the major form of DNA in the cell. The base pairs in the middle are aligned nearly ____________ to the helical axis. The _____ groove and the _____ groove are shown. Note that the strands are ____________.

deoxyribose, 2, hydroxyl, ribose, RNA, 5, 3, 5, 3, perpendicular, major, minor, antiparallel

Anemia is not a disease but rather a symptom complex that may result from one of three underlying causes: (1) decreased ____________ of RBCs (____ deficiency, _____________ anemia, ______ deficiency), (2) _____ loss, or (3) increased rate of ______________ of circulating RBCs (hypersplenism, _____________ destruction).

destruction, iron, pernicious, folate blood destruction, autoimmune

Vasopressin deficiency causes the condition known as ________ _________, in which large amounts of dilute urine are excreted.

diabetes insipidus

Treatment of patients with chronic renal failure often requires _____________ and long-term use of ___________ _______________

dialysis, recombinant erythroploietin

Zinc supplements are used in the treatment of ________ in children

diarrhea

Specific inhibitors of vitamin K-dependent carboxylation are used in the treatment of thrombosis-related diseases, e.g. in patients with deep vein thrombosis and pulmonary thromboembolism, or those with atrial fibrillation who are at risk of thrombosis. These are the drugs of the __________ group, e.g. ________, which inhibit the action of vitamin K

dicomurian, Warfarin

HIV drug: RT is inhibited by nucleoside analog drugs, including AZT, dideoxyinosine, and ________________, that are phosphorylated by cellular enzymes and incorporated into the cDNA, thereby causing DNA chain termination.

dideoxycytidine

Assessment of micronutrient status is _________ for several reasons

difficult

Anemia: Screening tests should include complete and ______________ _____ counts, a smear for cell _______________ study, determination of __ or ____________, a __________ test (for African American patients), and ___________ count.

diffrential blood, morpological, Hb, hematocrit, Sickledex, platelet

The _______ ______ _____ expand rapidly to overgrow the ________ ______ ___ and consequently this median swelling contributes little to the adult tongue.

distal tongue buds, median tongue bud

A range of drugs is used in the modern treatment of hypertension. These include __________ such as bendrofluazide, drugs blocking _______________, inhibitors of the ___ and the antagonists of ___________ receptors type _

diuretics, adrenoreceptors, ACE, angiotensin, I

The three-dimensional structure of the DNA ______ _____ is such that the deoxyribosyl phosphate backbones of the two strands are slightly offset from the center of the helix.

double helix

•Retroviruses are ___________ viruses with a ________-strand ___ genome that is transcribed into ___ by _______ ___________. The DNA is then integrated into the host cell genome.

enveloped, positive, RNA, DNA, reverse transcriptase

The body constantly exchanges water with the ___________

environment

Hemolytic anemias are caused by immune attack, ____________ factors (infection, splenomegaly, drugs, eclampsia), disorders of the RBC membrane (________________), enzymopathies (____ deficiency), and hemoglobinopathies (______ ____ anemia, thalassemia).

extrinsic, spherocytosis, G6PD, sickle cell

The extra X chromosome in cells of female mammals forms ___________ ______________ and can be seen as the ____ ____

facultative heterochromatin, Barr body

Glucose transporters catalyze downhill transport of ________ into and out of cells

glucose

When the blood concentration of glucose increases, glucose is transported into the β-cell through a ________ transporter (____-_) and metabolized, resulting in an increase in cytoplasmic ATP concentration.

glucose, GLUT 2

Structure and synthesis of vitamin C (ascorbic acid). Note that the enzyme that converts ______________ to ________ ____ is absent in man and higher primate

glutonolactone, ascorbic acid

Glycogen accumulates within cells in a group of closely related genetic disorders collectively referred to as _________ _________ _________, or _______________

glycogen storage diseases, glycogenoses

Deposition of ____________: in macrophages of patients with defects in lysosomal enzymes that break down glycogen (_________ ________ __________)

glycogen, glycogen storage diseases

intrinsic factor is a ____________

glycoprotein

Some apoptotic bodies express adhesive ______________ that are recognized by phagocytes, and _________________ themselves may produce proteins that bind to apoptotic cells (but not to live cells) and target the dead cells for engulfment.

glycoproteins, macrophages

HIV: The virus binds to the CD4+ lymphocyte cell surface specifically through the highly glycosylated outer surface envelope (_____) proteins.

gp120

HIV replication cycle: The infection begins when the envelope glycoproteins _____/____ (____) bind to the CD4 receptor and the _____________ receptor (_____), leading to a conformational change and exposing the ____ _-terminus. This hydrophobic peptide segment is inserted into the host cell membrane and facilitates the fusion of the viral membrane with that of the cell. The nucleocapsid is uncoated, the viral ___ genome enters the cytoplasm, and reverse transcription results in a _______-stranded ___ copy of the viral genome. A __________________ complex is formed with the participation of viral and cellular proteins, including the integrase and capsid, and mediates the entry of the viral genome into the nucleus. Integrase facilitates the integration of the viral DNA into the chromosome, with the participation of a host protein. The integrated, provirai DNA is transcribed by the host ___ ___________ __. The mRNA transcripts are translated into polyproteins, and the genome-length RNA and the proteins are incorporated into the HIV virions. After virus budding from the cell membrane, the ____________ produces the individual proteins in a process known as maturation.

gp120 gp41, env, chemokine, CXCR4, gp41 N, NRA, double, DNA, preinititation, RNA polymerase II, protease

The replication cycle of HIV-1 begins with binding of _____ to ___ (via a constant region on _______) and to a secondary receptor (via the variable __ loop region on _______).

gp120, CD4, gp120, V3, gp120

HIV is an enveloped RNA retrovirus about 100 nM in diameter. Glycoproteins (____ and _____) stud the surface of the envelope and serve to bind to human cells

gp41, gp120

HIV: The envelope, env, gene codes for the transmembrane ____ protein and the surface protein _____, which form trimers and are trafficked to the plasma membrane.

gp41, gp120

The daily body requirements for minerals range from ____ (sodium, calcium, chloride, phosphorus) through ________ (iron, iodine, magnesium, manganese, molybdenum) to _________ (zinc, copper, selenium, other trace elements) amounts

gram, milligram, microgram

Caseous necrosis is encountered most often in foci of tuberculous infection. Caseous means "cheese-like," referring to the friable yellow-white appearance of the area of necrosis. On microscopic examination, the necrotic focus appears as a collection of fragmented or lysed cells with an amorphous granular pink appearance in the usual H&E-stained tissue. Unlike with coagulative necrosis, the tissue architecture is completely obliterated and cellular outlines cannot be discerned. The area of caseous necrosis is often enclosed within a distinctive inflammatory border; this appearance is characteristic of a focus of inflammation known as a ___________

granuloma

On activation, CTL granule proteases called ____________ enter the target cells.

granzymes

DNA ______ participates in separation of the strands.

gyrase

Sickle cell anemia: These manifestations include jaundice, pallor, dactylitis (____ and ____ warmth and tenderness), leg ulcers, organomegaly, cardiac failure, stroke, attacks of abdominal and bone pain (________ ___________), and delays in growth and development

hand, foot, aseptic anemia

The second meiotic division occurs with no intervening S phase and separates the sister chromatids into two final cells that are _________

haploid

Vitamin supplementation can be _______

harmful

Natriuretic peptides are important markers of _____ _______

heart failure

Complementary strands of DNA spontaneously hybridize to form _______ structures

helical

DnaB has ________ activity that catalyzes ATP-mediated unwinding of the DNA helix

helicase

Chronic activation of ______ _ cells in response to the large amounts of HIV antigen produced may lead to the terminal differentiation and death of the cells.

helper T

In patients with AIDS who have no ______ _ cells and cannot mount normal __________ responses, organisms that would otherwise cause ______________ inflammation (e.g., M. avium complex) fail to do so

helper T, cellular, granulomatous,

Fungal infections tend to be progressive and debilitating in individuals with depressed immune systems, such as those with impaired neutrophil function and depressed _______ T cell (___) immune responses resulting from leukemia, Hodgkin disease, steroid treatment, or AIDS.

helper, Th1

HIV can kill ______________ precursor cells and damage the microenvironment needed for the differentiation of these cells in the bone marrow and thymus. These tissues may not be able to regenerate, thus adversely affecting the immune system.

hematopoietic

Vitamin B12 is part of the ____ structure

heme

Premature infants are especially at risk of deficiency of VItamin K and may develop the ____________ _______ __ ___ _______

hemmorrhagic disease of the newborn

Screening tests for Heinz bodies (___________ precipitates)or NADPH may be used to detect G-6-PD deficiency.

hemoglobin

Iron is a component of heme in __________ and _________. Cytochromes _, _, and _ also contain iron

hemoglobin, myoglobin, a, b, c

A partial list includes genetic disorders that produce aberrant RBCs that result in RBC destruction (___________), nutritional disorders that limit the production of RBCs, immune-mediated disorders that result in attacks on RBCs, bleeding disorders that cause loss of RBCs, chronic diseases (__________ ____________), infections, and diseases of bone marrow

hemolysis, rheumatoid arthritis

Patients with _________ anemia (e.g., sickle cell anemia) may show pallor and oral evidence of jaundice caused by hyperbilirubinemia caused by excessive erythrocyte destruction.

hemolytic

Skull film in a patient with _________ anemia shows new bone formation on the outer table, producing perpendicular radiations or "hair on end" appearance.

hemolytic anemia

Fatty change: It is principally encountered in cells participating in fat metabolism (e.g., _____________, __________ cells) and is also reversible.

hepatocytes, myocardial

________________ transmission (____ to ______ or _______ to ____) is the second most common form of transmission in the United States but accounts for 80% of the world's HIV infections

heterosexual, male, female, female, male

GLUT 1 mutation: The Tmax for uptake of glucose by the patient's erythrocytes was 60% of the mean normal value, suggesting a _______________ defect

heterozygous

Impaired glucose transport: A ketogenic diet (a ____-fat, ____-protein, _____-carbohydrate diet) was started, since the brain can use ketone bodies as oxidizable fuel sources, and the entry of ketone bodies into the brain is not dependent on the glucose transporter system.

high, low, low

proBNP (1-76) reaches _______ levels in cardiac failure than BNP 32. Similarly, proANP (1-98) has a _______ half-life in plasma than biologically active 1-28 ANP and therefore is present in the circulation in ______ concentrations.

higher longer, higher

The incidence of Kaposi sarcoma in the United States declined from 1,838.9 cases per 100,000 person-years in 1990-1995 to 334.6 in 1996-2002. The incidence of non-Hodgkin lymphoma also declined from 1,066.2 cases per 100,000 person-years in 1990-1995 to 390.1 cases in 1996-2002. These declines may be the result of the restoration of CD4+ lymphocyte levels in HIV-seropositive individuals following _____ ______ ________________ _______

highly active antiretroviral threapy

Since the introduction of protease inhibitors in 1996 and the advent of ______ ______ ______________ therapy (_____), the epidemic of AIDS in the United States has slowed and stabilized.

highly active retroviral HAART

The period of DNA (and _______) synthesis is the S phase.

histone

One enzyme involved in enabling histone proteins to compact DNA is _______ ___________, which removes acetyl groups bound to lysines.

histone deacetylase

The DNA molecule initially wraps around complexes of basic proteins called ________ to form ___________, producing a structure resembling beads on a string.

histones, nucleosomes

The A-form is observed when the DNA strands contain tracks of polypurine (and complementary polypyrimidine) residues. These regions do not efficiently bind ________ and are therefore unable to form ___________, resulting in __________-free regions of DNA.

histones, nucleosomes, nucleosome

Cells normally maintain a steady state called ___________ in which the intracellular milieu is kept within a fairly narrow range of physiologic parameters

homeostasis

Functions of vitamin B12 and folate are interrelated, and deficiency of either produces the same signs and symptoms. The reaction, which involves both these vitamins is the conversion of ____________ to __________

homocysteine, methionine

The 'tetrahydrolate trap'. Vitamin B12 and folate are involved in the conversion of ___________ to __________. An absence of vitamin B12 inhibits the reaction and leads to the build-up of _______

homocysteine, methionine, N5MeTHF

Periapical radiograph of the mandible in a patient with sickle cell anemia. Note the prominent ____________ trabeculations and the dense _______ _____

horizontal, lamina dura

The two types of physiologic hyperplasia are (1) __________ hyperplasia, exemplified by the proliferation of the glandular epithelium of the female breast at puberty and during pregnancy, and (2) _____________ hyperplasia, in which residual tissue grows after removal or loss of part of an organ

hormonal, compensatory

Apoptosis: Involution of ___________-dependent tissues upon hormone deprivation, such as _______________ cell breakdown during the menstrual cycle, and regression of the __________ breast after weaning

hormonal, endometrial, lactating

Vitamin D (calciol) is a _______

hormone

Lipids are mobilized from adipocytes by _______-_________ ______ activated by ________________ released from the adrenal gland and various peptide hormones.

hormone sensitive lipase, norepinepherine

Physiologic adaptations usually represent responses of cells to normal stimulation by hormones or endogenous chemical mediators (e.g., the _______-induced enlargement of the _____ and ______ during pregnancy)

hormone, breast, uterus

Na+/K+-ATPase activity is subject to short- and long-term regulation by a number of ________

hormones

The arthroconidia of C immitis have an outer wall containing small, cysteine-rich peptides called _____________ that have antiphagocytosis properties.

hydrophobins

cellular swelling: This pattern of nonlethal injury is sometimes called __________ change or ___________ degeneration.

hydropic, vaculoar

On the EKG, _____________ can lead to the loss of P-wave, characteristic tall peaked T-waves, and widened QRS complexes

hyperkalemia

Both high and low concentrations of potassium (____________ and ___________, respectively) affect the _______ muscle and can be life-threatening.

hyperkalemia, hypokalemia, cardiac

characterized by an increase in cell number because of proliferation of differentiated cells and replacement by tissue stem cells.

hyperplasia

HIV: Uninfected cells ("________ __________") may be killed by cytotoxic T cells that recognize HIV bound to the surface of the cell in a process known as antibody-dependent cellular cytotoxicity. Cytotoxic T cells may also destroy uninfected cells that have taken up HIV particles and present viral fragments on their surface.

innocent bystanders

Approximately two-thirds of total body water is in the _____________ fluid (___), and one-third remains in the ______________ fluid (___). ECF consists of ____________ fluid and _____ (15% body weight), ______ (3% body weight), and the so-called _____________ fluids, which include gastrointestinal fluid, urine and cerebrospinal fluid (___)

intracellular, ICF, extracellular, ECF, interstitial, lymph, plasma, transcellular

Vitamin B12 requires the _________ ______ for its absorption

intrinsic factor

Pernicious anemia is caused by a deficiency of _________ ________, a substance secreted by the stomach _________ cells that is necessary for absorption of vitamin ___

intrinsic factor, pareital, B12

Certain fungal cell surface proteins (_________), such as Als3 (which is also an ________), can interact with E-cadherin on epithelial cells and N-cadherin on endothelial cells and induce endocytosis.

invasins, adhesin

Primary active transport systems use ATP to drive ion pumps (___ _____________ ATPases or ____ ATPases)

ion transporting, pump

Channels are often pictured as tunnels across the membrane, in which binding sites for substrates (_____`) are accessible from either side of the membrane at the same time

ions

Deficiencies in ____ would reveal a microcytic anemia, low serum ferritin, low serum iron, and a high total iron-binding capacity

iron

In microcytic anemia (____ deficiency), the physician should look for a source of bleeding.

iron

In patients who have undergone a gastrectomy, _____ supplements (ferrous sulfate, ferrous fumarate or ferrous gluconate) are provided on a long-term basis

iron

Smooth red tongue and angular cheilitis in a patient found to have ____ __________ anemia.

iron defeciency

mild ____ ____________ anemia in men usually indicates the presence of a serious underlying medical problem (e.g., gastrointestinal bleeding, malignancy).

iron defeciency

Some patients with ____ _______________ anemia develop Plummer-Vinson syndrome, which is characterized by a sore mouth, dysphagia (resulting from muscular degeneration in the _______________ with esophageal ___________ or "____________"), and an increased frequency of carcinoma of the oral cavity and pharynx.

iron defweceincy, esophagus, stenosis, webbing

Although there are no definitive morphologic or biochemical correlates of irreversibility, two phenomena consistently characterize ______________: the inability to correct mitochondrial dysfunction (lack of oxidative phosphorylation and ATP generation) even after resolution of the original injury, and profound disturbances in membrane function.

irreversibality

Structure, metabolism and function of vitamin A. Conversion of retinaldehyde to retinoic acid is _____________

irreversible

Persistent or excessive injury, however, causes cells to pass the nebulous "point of no return" into ____________ _______ and ____ _____

irreversible injury, cell death

If ischemia persists, ______________ injury and ___________ ensue

irreversible, necrosis

Cell death is one of the most crucial events in the evolution of disease in any tissue or organ. It results from diverse causes, including ________ (lack of blood flow), infections, toxins, and immune reactions.

ischemia

Hypoxia should be distinguished from __________, which is a loss of blood supply in a tissue due to impeded arterial flow or reduced venous drainage.

ischemia

If the increased demand is not relieved, or if the myocardium is subjected to reduced blood flow (________) from an occluded coronary artery, the muscle cells may undergo injury

ischemia

____________ injures tissues faster and usually more severely than does hypoxia.

ischemia

While _________ is the most common cause of hypoxia, oxygen deficiency can also result from inadequate oxygenation of the blood, as in pneumonia, or from reduction in the oxygen-carrying capacity of the blood, as in blood loss anemia or _______ _________ poisoning.

ischemia, carbon monoxide

Coagulative necrosis is a form of necrosis in which the underlying tissue architecture is preserved for at least several days. The affected tissues take on a firm texture. Presumably the injury denatures not only structural proteins but also enzymes, thereby blocking the proteolysis of the dead cells; as a result, eosinophilic, anucleate cells may persist for days or weeks. Leukocytes are recruited to the site of necrosis, and the dead cells are digested by the action of lysosomal enzymes of the leukocytes. The cellular debris is then removed by phagocytosis. This necrosis is characteristic of infarcts (areas of ________ ___________) in all of the solid organs except the _____.

ischemic necrosis, brain

Premature graying of hair and yellowing of the skin (due to ________) have been reported with ___________ anemia

jaundice, pernicious

Renin is an enzyme produced principally in the ________________ _________ of the kidney; it is stored in the secretory granules and released in response to a ________ renal perfusion pressure (decreased delivery of ___ to the ______ _____) and _________ sympathetic tone.

juxtaglomerular apparatus, decreased, Na+, macula densa, increased

Nuclear changes in necrosis: Nuclear changes assume one of three patterns, all due to breakdown of DNA and chromatin. The basophilia of the chromatin may fade (____________), presumably secondary to deoxyribonuclease (________) activity. A second pattern is ___________, characterized by nuclear shrinkage and increased basophilia; the DNA condenses into a solid shrunken mass. In the third pattern, _________________, the pyknotic nucleus undergoes fragmentation. In 1 to 2 days, the nucleus in a dead cell may completely disappear. Electron microscopy reveals profound nuclear changes culminating in nuclear dissolution.

karyolysis, RNAse, pynkosis, karryorhexis

Antacids, phenytoin, cimetidine, and rifampin should not be given to patients who are being treated with ____________, because of the possibility of altered absorption and metabolism.

ketoconazole

Melanin pigmentation has been reported to occur in HIV-infected patients. Several of the medications (_____________, ______________, and _________) used to treat these patients may cause melanin pigmentation. Addison-like pigmentation also may occur because of destruction of the adrenal gland. HIV infection itself may cause melanin pigmentation.

ketoconazole, clofazimine, zidovuine

The _______ plays important parts in preservation of water and electrolyte homeostasis

kidney

Vitamin D deficiency may be caused by insufficient exposure to sunlight or increased metabolism of vitamin D due to low calcium intake or absorption. Deficiency may also develop in ______ disease, ___ malabsorption (in cystic fibrosis, Crohn's disease and after gastric bypass).

kidney, fat

Adipocytes of white fat are typically very _____ cells, ranging in diameter from 50 to 150 μm.

large

The distal tongue buds (_______ _______ ________) expand rapidly to overgrow the median tongue bud (__________ _______) and consequently this median swelling contributes little to the adult tongue.

lateral lingual swellings, tuberculum impar

Microcytic anemia caused by Inhibition of hemoglobin synthesis

lead poisoning

Water always diffuses from _____ osmolality to ______ to equalize _______ pressures

lower, higher, osmotic

Because water and sodium transport on the _______ side of the epithelial cells (in the _________ and the _______) is linked to the ion gradient generated by the Na+/K+-ATPase, this enzyme is critical to water absorption in the intestine and its reabsorption in the kidneys.

luminal, intestine, kidneys

During clinical latency, HIV-1 still replicates in _____ _____ and is trapped by __________ _________ cells located in _______ _______. The complex, fine structure of the lymph node deteriorates, and ____ tissue is formed.

lymph nodes, follicular dendritic, germinal centers, scar

The AIDS virus agent was isolated from patients with __________________ (abnormal enlargement of the lymph nodes) and AIDS by Françoise Barré-Sinoussi and Luc Montagnier at the Pasteur Institute in 1983.

lymphadenopathy

HIV virus, initially called _________________ ____________ _______

lymphadenopathy associated virus

HIV-1 was first identified in 1983 by Francoise Barre-Sinoussi in the lab of Luc Montaignier of the Pasteur Institute. They first called it _______________ ___________ _____

lymphadenopathy associated virus

Apoptosis: Elimination of potentially harmful self-reactive ____________, either before or after they have completed their maturation, in order to prevent reactions against the body's own tissues

lymphocytes

____________ anemia. Peripheral blood smear shows a hypersegmented neutrophil with a six-lobed nucleus.

megaloblastic

Folate deficiency in adults causes _____________ ______

megaloblastic anemia

HIV: Monocytes, macrophages, and dendritic cells, as well as ______ _cells that get infected later, act as reservoirs of the virus

memory T

The anterior two-thirds of the tongue, the 'oral tongue', develops from three swellings: two distal tongue buds (lateral lingual swellings) and a median tongue bud (tuberculum impar) Each is formed by proliferation of ____________ beneath the endodermal lining of the ___ pharyngeal (___________) arch.

mesenchyme, 1st, branchial

To render diagnoses and guide therapy in clinical practice, pathologists identify changes in the gross or microscopic appearance (__________) of cells and tissues, and biochemical alterations in body fluids (such as _____ and _____)

morphology, blood, urine

HIV-1 enters the host through a break in ________ surfaces and infects the ________-associated ________ tissue. __________, ____________, and ___________ cells, as well as memory T cells that get infected later, act as reservoirs of the virus.

mucosal, mucosa, lymphoid, Monocytes, Macrophages, dendritic

CF: The pancreatic and lung pathology results from the increased viscosity of secreted fluids (_________________).

mucoviscoidosis

The HIV genome can be transferred from cell to cell via cell-cell fusion, leading to ______________ _________

multinucleated syncytia

Megaloblastic anemia in pregnancy (other than ________ _________) is rare. However, folate deficiency increases the risk of _______ ____ _______, ___ birth weight and __________ birth. In infants it results in a __________ growth rate.

multiple pregnancy, neural tube defects, low, premature, decreaesd

Mutation in a water channel protein gene (aquaporin-2) causes diuresis in patients with __________ ________ _________, a disease characterized by excessive urination but without the hyper-glycemia characteristic of diabetes mellitus

nephrogenic diabetes insipidus

in disorders with heavy protein leakage across the glomerular filter (e.g., __________ __________), there is a much larger reabsorption of the protein, and vesicles containing this protein accumulate, giving the histologic appearance of pink, hyaline cytoplasmic droplets

nephrotic syndrome

Apoptosis: Elimination of cells that have served their useful purpose, such as _____________ in an acute inflammatory response and ______________ at the end of an immune response. In these situations, cells undergo apoptosis because they are deprived of necessary survival signals, such as ______ __________

neutrophils, lymphocytes, growth factors

Although there are no definitive morphologic or biochemical correlates of irreversibility, two phenomena consistently characterize irreversibility: the inability to correct mitochondrial dysfunction (lack of __________ ________________ and ___ generation) even after resolution of the original injury, and profound disturbances in membrane function.

oxidative phosphorlyation, ATP

When the production of ROS increases or the scavenging systems are ineffective, the result is an excess of these free radicals, leading to a condition called _________ _______

oxidative stress

Riboflavin is associated with ________________

oxidoreductases

Oxidative damage to DNA. 8-Oxo-2′-deoxyguanosine (____) is an oxidative modification of DNA that causes mutations during replication of DNA. Replication of the strand containing oxoG frequently yields a __________ _ in the complementary strand, which, on further replication, yields an __ base pair, instead of the original __ base pair.

oxoG, pyrimidine A, AT, GC

________ free radicals cause injury to cell membranes by lipid peroxidation

oxygen

Copper is associated with ________ enzymes including cytochrome oxidase and superoxide dismutase (the latter also requires ____)

oxygenase, zinc

Abbott has developed a combination assay, the ARCHITECT HIV Ag/Ab Combo assay (Abbott Laboratories, Abbott Park, Illinois), that can simultaneously detect the combined presence of HIV antigens (the ___ antigen produced by HIV) and antibodies to HIV.

p24

The structure of human immunodeficiency virus, showing the ___ capsid protein surrounding _ strands of viral ___

p24, 2, RNA

HIV: he group-specific antigen gene, gag, encodes the capsid (___), nucleocapsid (__), and matrix (___) genes.

p24, p7, p17

HIV: Internal to the envelope is a protein capsid (___) that surrounds essential viral enzymes (_________, _________, _______ _______________) and an ___ inner core

p41, protease, integrase, reverse transcriptase, RNA

Abnormal intracellular accumulation: Inadequate removal of a normal substance secondary to defects in mechanisms of ___________ and _________, as in fatty change in the ______

packaging, transport, liver

Metastatic calcification: deposition of calcium in normal tissues, caused by hypercalcemia (usually a consequence of _____________ _________ excess)

parathyroid hormone

The posterior third of the tongue, the '____________ tongue', develops from a single midline swelling, the ____________ _________, which is derived mainly from the __ pharyngeal (______________) arch (with a small contribution from the ___ arch).

pharyngeal, hypopharyngeal eminence, 3rd, branchial, 4th

The yeast-to-hyphal transformation (___________ _________) of C albicans is instrumental in its penetration through epithelial cell surfaces and adaptation to changes in the microenvironment

phenotypic switching

Increased cytosolic Ca2+ activates a number of enzymes, with potentially deleterious cellular effects. These enzymes include _______________ (which cause membrane damage), ____________ (which break down both membrane and cytoskeletal proteins), ________________ (which are responsible for DNA and chromatin fragmentation), and __________ __________________ (thereby hastening ATP depletion)

phosphlipases, proteases, endonuceleases, adenosine triphosphatases

Severe cell injury is associated with increased degradation of membrane _____________, probably owing to activation of endogenous phospholipases by increased levels of cytosolic Ca2+.

phosphoplipids

The production of __________________ in cells may be reduced whenever there is a fall in ATP levels, leading to decreased energy-dependent enzymatic activities. The reduced ____________ synthesis may affect all cellular membranes, including the membranes of mitochondria, thus exacerbating the loss of ATP.

phosphoplipids, phosphlipid

Prolonged or worsening depletion of ATP causes structural disruption of the _______ __________ apparatus, manifested as detachment of ribosomes from the _____ __ and dissociation of polysomes into monosomes, with a consequent reduction in protein synthesis. Ultimately, there is irreversible damage to mitochondrial and lysosomal membranes, and the cell undergoes necrosis.

protein synthetic, rought ER

Deposition of ___________: reabsorbed proteins in kidney tubules; immunoglobulins in plasma cells

proteins

Acidification of gastric juice is done by a _______ _____ in the stomach

proton pump

The lumen of the stomach is highly acidic (pH ≈_) because of the presence of a ________ pump (__/__ _______, _-________) that is specifically expressed in gastric parietal cells.

proton, H+ K+ ATPase, P ATPase

HIV: If the cell is in a growth phase, the complex is integrated into the host chromosome via the action of the viral integrase, forming the __________

provirus

Kidney: Most of the Na+ reabsorption in the tubules occurs in _________ segments.

proximal

Na+/H+-antiporter (NHE3) mediates Na+ entry in the ________ _______

proximal tubule

PKC and PKA act on which amino acids in the alpha subunit of Na+ K+ ATPase?

serine

More than 50% of persons exposed to HIV develop an acute and brief viremia (_______________ ________) within 2 to 6 weeks of HIV exposure and then develop antibodies (anti-___, anti-_____, anti-___) between weeks 6 and 12

seroconversion sickness, gag, gp120, p24

The AIDS-defining conditions set by the CDC are HIV ________________ and ____ lymphocyte counts less than ___/mm3.

seropositivity, CD4+, 200

Retinol is secreted from the liver bound to _____ _______ _______ _______ (___)

serum retinol binding protein, RBP

HIV is transmitted primarily by _______ contact, _____ transfusion, and ______-to-_____ transmission.

sexual, blood, mother, child

Inflammation and breaks in the skin or mucosa (e.g., presence of other _________ ___________ ________) and high concentrations of HIV in bodily fluids increase the risk of transmission.

sexually transmitted diseases

Further deterioration from thiamine defeciency results in mental confusion (loss of _____-term memory), ataxia and loss of eye coordination.

short

Sickle cell patient: If required, nitrous oxide-oxygen (N2O-O2) should be used for ______ periods, with at least __% oxygen concentration provided.

short, 50

For routine dental care, appointments should be _____ (to reduce ______) for patients with sickle cell anemia.

short, stress

Severe deficiency of Vitamin B6 is also associated with a _____________ anemia (anemia characterized by the presence of nucleated red blood cells with iron granules)

sideroblastic, iron

Some small, neutral molecules can traverse biomembranes by ______ _________

simle diffusion

Coiled Trichinella spiralis larva within a ________ _______ cell.

skeletal muscle

Striated muscle (___________ and __________) is composed of bundles of muscle cells

skeletal, cardiac

Some _____, ________ molecules can traverse biomembranes by simple diffusion

small, neutral

Brown fat: Adipocytes of this tissue are typically __________ than those of white fat and contain primarily _____ small _____droplets (they are ______________) in cytoplasm containing many mitochondria and a central nucleus.

smaller, many, lipid, multilocular

Serum ______ concentration is a marker of fluid and electrolyte disorders

sodium

Some hormones appear to alter the Na+/K+-ATPase activity by changing its apparent affinity for ______ (for instance, angiotensin II and insulin increase the affinity). ok file.

sodium

Water and _______ metabolism are closely interrelated.

sodium

Whereas etiology refers to ___ a disease arises, pathogenesis describes ___ a disease develops.

why, how

Causes of atrophy include a decreased __________ (e.g., immobilization of a limb to permit healing of a fracture), loss of ______________, diminished _____ supply, inadequate _________, loss of _________ stimulation, and ______ (senile atrophy)

workload, innervatino, blood, nutrition, endocrine, aging

The _____-to-________ transformation (phenotypic switching) of C albicans is instrumental in its penetration through epithelial cell surfaces and adaptation to changes in the microenvironment

yeast, hyphal

Fungi can exist as _______ (also known as blastospores) or as _____

yeasts, molds

acetaminophen should be used with caution in patients treated with ________ (________) because studies have suggested that granulocytopenia and anemia, associated with __________, may be intensified; also, aspirin should not be given to patients with thrombocytopenia.

ziduovine, Retrovir, zidouvine

The sources of ____ include oysters (highest content), red meat, poultry, beans and nuts

zinc

Atrophy as seen in the brain. A, Normal brain of a young adult. B, _________ of the brain in an 82-year-old man with atherosclerotic disease. Atrophy of the brain is due to _________ and reduced ______ supply. Note that loss of brain substance narrows the ____ and widens the _____. The _________ have been stripped from the bottom half of each specimen to reveal the surface of the brain.

atrophy, aging, blood, gyri, sulci, meninges

Apoptosis can be due to Pathologic __________ in _______________ organs after duct obstruction such as the pancrease, ________ gland, and kidney

atrophy, parenchymal, parotid

Phenytoin AKA

Dilantin

Benzothiazepine AKA

Diltiazem

Angiotensin II-induced vasoconstriction: The angiotensin type _ receptor (____) is coupled to G-proteins. The binding of ___________ __ leads to ____________ _-mediated formation of ___ and ___. This mobilizes ____ from the ____________ _________, and causes entry of the extracellular ____ through activated _______ channels. An ________ in the cytosolic Ca2+ initiates contractile response of the vascular smooth muscle cells. Ca2+ subsequently binds to ___________. The Ca2+-calmodulin complex activates ______ _____ _____ ______. The kinase phosphorylates myosin light chains and elicits muscular tension. This effect is terminated by the _________________ of myosin. ___ receptor ___________, such as losartan, inhibit _______________ effects of angiotensin II and are used in the treatment of ____________.

1, ATR1, angiotensin II, phospholipase C, IP3, DAG, Ca2+, sarcoplasmic reticulum, Ca2+, calcium, increase, calmodulin, myosin light chain kinase, dephosphorlyation, AT1, antagonists, vasoconstrictor, hypertension

Genes for specific proteins are unique DNA sequences that are present in single copies or at most only a few copies per genome. There are also several types of repeated DNA sequences within the genome. These are divided into two major classes: middle repetitive (<__ copies per genome) and highly repetitive (>__ copies per genome).

10, 10

Na+/K+-ATPase. The α-subunit consists of __ membrane-spanning domains (__-___) with intracellular ______- and _______-terminal domains. The ATP-binding domain and the phosphorylation site are located in the long __-__ cytoplasmic loop (where ___ residue undergoes phosphorylation). Other phosphorylation sites on ______ and ________ residues are mediated by _______ ______ _, _______ ______ _, ________ ______

10, M1, M10, carboxy, amino, M4, M5, Asp, serine, tyrosine, Protein Kinase A, Protein Kinase C, Tyrosine Kinase

Although <__% of Na+ reabsorption occurs in the distal nephron, this site is recognized to be essential for fine-tuning of plasma volume since Na+ reabsorption in the distal nephron is sensitive to the __________ hormone _____________.

10, steroid, aldosterone

HAART: If the viral load is high (greater than _______ RNA copies/mL), therapy can be considered even if the helper T cell numbers are greater than ___/μL.

100,000, 350

The remainder of the proteins that are found in mitochondria (about ____) are produced from _______ genes, synthesized in the cytoplasm on 'free' _________, then imported into the mitochondrion

1000, nuclear, ribosomes

Anemia generally is defined as Hb level less than __ g/dL for women and less than __ g/dL for men.

12, 13

Approximately 4% of men and 8% of women in the United States have anemia, defined as Hb values below __ g/dL for men and below __ g/dL for women

13, 12

The overall prevalence of HIV (among persons older than __ years of age) is 70.8 for ______ men who have sex with ___ (___) and 14.6 for _____ MSM per 100,000,10 and the number of cases of HIV infection due to heterosexual transmission remains greater than 15,000 per year

13, black, men, MSM, white

delta Na+ across cell membrane? deltaV across cell membrane?

130 mMol 60- 90 mV

Thiamine depletion can occur quickly (within approximately __ days), Early symptoms are loss of appetite, constipation and nausea

14

K+, Na+ and Ca2+ concentrations in the cytoplasm are maintained at ∼___, __, and __^__ mmol/L, respectively, by transport proteins, whereas those outside (in the blood) are ∼_, ___, and _-_ mmol/L, respectively

140, 10, 1 -4, 5, 145, 1, 2

SGLT1: Concentration of Na+ in the filtrate is ____/L (322 mg/dL), while that inside the epithelial cells is __ mmol/L (69 mg/dL), so that Na+ flows 'downhill' along its gradient, dragging glucose 'uphill' against its concentration gradient

140, 30

K+ leaks out through K+ channels, down its concentration gradient (___ mmol/L to _ mmol/L), further increasing the electric potential in Na+ K+ ATPase

140, 5

In the case of Na+ ions, the concentration difference between outside (___ mmol/L) and inside (__ mmol/L) the cell is about a factor of 10, being maintained by the Na+/K+-ATPase.

145, 12

Long-term survival with HIV infection (beyond __ years) occurs and is associated with less virulent HIV strains, lower-level viremia, HAART, and robust immune responses

15

The normal ratio of T helper to T suppressor lymphocytes is about _:_ (__% T helper, __% T suppressor)

2, 1, 60, 30

Aquaporins: AQP _ and _ are present in the collecting duct and are regulated by vasopressin. AQP_ is expressed on the apical and basolateral membranes of the proximal tubules and in the descending loop of Henle, and is not under vasopressin control. It is also present in erythrocytes, renal proximal tubular cells, and in the capillary endothelium.

2, 3 1

The initial HIV infection may be asymptomatic or may be followed within _ to _ weeks by the _____ phase.

2, 4, acute

Structures involved in chromosome packaging. (A) The nucleosome core is composed of _ subunits each of ___, ___, __, and __. The core is twice wrapped with ___, and the __ histone binds to the completed complex. (B) The ___ angrstrom chromatin filament is formed by wrapping the nucleosomes into a ______-shaped _________. (C) The chromosome is composed of the ___ Å filaments, which bind to a nuclear _________, forming large loops of _________ material. (D) The end view of a chromosome shows the central nuclear ________ surrounded by the radial loops of _________. The diameter of a chromosome is about _ µm.

2, H2A, H2B, H3, H4, DNA, H1, 300, spiral, solenoid, 300, scaffold, chromatin, scaffold, chromatin, 1

Using X-ray diffraction photographs of DNA taken by Rosalind Franklin, James Watson and Francis Crick proposed a structure for DNA in 1953. This model proposed that DNA was composed of _ intertwined ___________ strands with ________ bonds holding the strands together

2, complementary, Hydrogen

In the A-form, the nucleotide base pairs are tilted __° relative to the helical axis and the helix diameter is increased, compared to the B-form

20

White adipose tissue is found in many organs throughout the body, typically forming about __% of the body weight in adults.

20

osteonecrosis of hip and shoulder joints, leg ulcers, priapism, liver disease, and gallstones Happens to sickle cell patients in what age group?

20 to 40 years

What % of body weight is ECF? What % of body weight is ICF?

20% 40%

There are five classes of histones, termed H1, H2A, H2B, H3, and H4. They are all rich (>__%) in ____________ charged, _____ amino acids (______ and _________).

20, positively, basic, lysine, arginine

The human genome contains ______-______ different protein coding genes spread over __ chromosome pairs

20,000, 23,000, 23

HIV infection is highest in what age group?

20-29

AIDS: As the CD4+ count drops and approaches ___ cells/µL, persons can exhibit weight loss, diarrhea, and night sweats

200

HAART: It is recommended that therapy be initiated if the patient has AIDS-defining illnesses or if the level of helper T cells drops to less than ___/μL.

200

HIV: Opportunistic infections predominate as the CD4+ T count approximates ___ cells/µL; then malignancies, wasting syndrome, and a progressive form of dementia can develop

200

Patients who are symptomatic for the early stages of AIDS (i.e., CD4+ cell count lower than ___) have increased susceptibility to opportunistic infection and may be medicated with prophylactic drugs.

200

Vaccines are recommended for HIV infected people before their CD4+ count hits ___/uL

200

The risk of HIV transmission from infected patients to health care workers is very low, reportedly about _ of every 1000 cases (___%) in which a needlestick or other sharp instrument transmitted blood from a patient to a health care worker

3, 0.3

As in intestinal epithelial cells, the low intracellular concentration of Na+ is maintained by an Na+/K+-ATPase on the opposite side of the tubular epithelial cell, which antiports _ cytoplasmic sodium ions for _ extracellular potassium ions, coupled with hydrolysis of a molecule of ATP.

3, 2

When the _′-end of the elongating Okazaki fragment reaches the _′-end of the previously synthesized Okazaki fragment, DNA polymerase III releases the template and finds another RNA primer further back along the lagging strand, synthesizing another Okazaki fragment

3, 5

Use of at least a _-drug PEP regimen is recommended for more severe exposure (_____-____ ______ needle, ____ puncture, visible _______ on device or needle used in patient's _______ or ____) or when the patient is symptomatic, has AIDS, or a high viral load.

3, large bore hollow, deep, blood, artery, vein

The B-form of DNA has a contour length of ___ Å per base pair.

3.4

The folate supplementation during the periconception period (definitions of that period are variable: the one used in clinical studies is _ weeks before and _ weeks after conception) prevents _____ ______, as the closure of the neural tube occurs between __ and __ days after conception.

4, 8, spina bifida, 22, 28

pulmonary hypertension, nephropathy, proliferative retinopathy, and cardiac enlargement, heart murmurs, and sudden death due to arrhythmias Happens to Sickle cell patients in what age group?

40 and up

AIDS is highest in what age group?

40-49

A majority of cases of aplastic anemia, however, are idipathic (__% to __%)

50, 65

During periods of undetectable virus in the blood (usually less than __ RNA copies/mL), large numbers of HIV accumulate in the ______ _____

50, lymph nodes

Thrombocytopenia: Platelet counts below ______/mm3 may result in significant bleeding with minor surgical procedures. Platelet replacement may be indicated for these patients.

50,000

Approximately ______ African Americans (about 0.003% to 0.15%), or 1 in ___, have sickle cell anemia

50,000, 600

Moderate aplastic anemia is defined as more than ___ neutrophils/µL, more than ______ platelets/µL, and more than ______ reticulocytes/µL.

500, 20,000, 20,000

Severe aplastic anemia is defined as (_ or more) neutrophils less than ___/µL, platelets less than ______/µL, and reticulocytes less than ______/µL

500, 20,000, 20,000

Pyridoxine is required for the synthesis of the neurotransmitters ___ and __, and the synthesis of ___________, a component of sphingomyelin and sphingolipids

5HT, NE, sphingosine

HIV gene expression is regulated by _ gene products called auxiliary proteins or accessory gene products

6

How long after HIV infection do you get lymphandopathy, thrush, fever, anorexia, weight loss, diarrhea?

8 years

After inhalation, B dermatitidis undergoes thermal dimorphism from the small conidia into the larger yeast form (_ to __ μm) that is difficult for neutrophils to phagocytose.

8, 30

More than 20 different oxidative modifications of DNA have been characterized; the most studied is 8-oxo-2′-deoxyguanosine (_-____)

8, oxoG

eliminated via renal filtration. Therefore, its urinary level is used as a sensitive biomarker for oxidative stress in many clinical studies What molecule?

8-Oxo-2'-deoxyguanosine

Normocytic anemia RBC size

80- 100 fL

In 1993, the Centers for Disease Control and Prevention (CDC) established AIDS-defining conditions as HIV seropositivity and CD4+ lymphocyte counts less than 200/mm3 (normal levels are ___ to _____/mm3).

800, 1,200

Patients who are short of breath and in whom Hb levels are less than 11 g/dL, an abnormal heart rate, or oxygen saturation less than __% (as determined by ______ __________) are considered medically unstable, and routine treatment should be deferred until their health status improves.

91, pulse oximetry

A 29-year-old woman presents with a 101°F fever, pericardial effusions and Libman-Sachs endocarditis, arthralgia, and facial rash across the malar region ("butterfly rash") that is accentuated by sun exposure. Laboratory tests show creatine 1.7 mg/dL (normal 0.5-1.1 mg/dL), high titers of antinuclear autoantibodies (ANA), Smith antigen, and antinucleosome antibodies in the blood. Which one of the following is most likely to be directly affected by the disruption of nucleosomes in this patient? a. Packaging of genetic material in a condensed form b. Transcribing DNA c. Forming pores for bidirectional nuclear-cytoplasmic transport d. Forming the nuclear lamina e. Holding together adjacent chromatids

A

Applied to adipocytes, the term "multilocular" refers to which of the following? a. The large number of small cytoplasmic lipid droplets b. The proliferation of the cells in an obese individual c. The large number of mitochondria in the cells d. The high density of nerves supplying the tissue e. The type of mesenchymal cells also present

A

Binding of histone H1 proteins to importins is important for which of the following? a. Transport through the nuclear pores complexes b. Properly directed vesicular transport through the Golgi apparatus c. Transport from the granular part of the nucleolus d. Further binding to the "linker DNA" and proper assembly of nucleosomes e. Phosphorylation of cyclins

A

Wuchereria bancrofti What type of pathogen?

Extracellular helminth

Several important antiviral drugs are nucleotide analogues that inhibit reverse transcriptase, including ___ (azido-2′,3′-dideoxythymidine; Retrovir, zidovudine), ___ (2′,3′-dideoxycytidine; Hivid, zalcitabine), and ___ (2′,3′-dideoxy-3′-thiacytidine; Epivir, lamivudine)

AZT, ddC, 3TC

Acquired Immunodefeciency Syndrome AKA

AIDS

CDC Stage 3 HIV AKA

AIDS

HIV What disease?

AIDS

Stage 3 HIV AKA

AIDS

____ is the world's leading cause of death in women and men aged 15 to 59 years.2

AIDS

•Bacterial infections, multiple or recurrent* •Candidiasis of bronchi, trachea, or lungs •Candidiasis of esophagus† •Cervical cancer, invasive§ •Coccidioidomycosis, disseminated or extrapulmonary •Cryptococcosis, extrapulmonary •Cryptosporidiosis, chronic intestinal (longer than 1 month in duration) •Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age >1 month •Cytomegalovirus retinitis (with loss of vision)† •Encephalopathy, HIV-related •Herpes simplex: chronic ulcers (>1 month's duration) or bronchitis, pneumonitis, or esophagitis (onset at age >1 month) •Histoplasmosis, disseminated or extrapulmonary •Isosporiasis, chronic intestinal (>1 month's duration) •Kaposi sarcoma† •Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex*† •Lymphoma, Burkitt (or equivalent term) •Lymphoma, immunoblastic (or equivalent term) •Lymphoma, primary, of brain •Mycobacterium avium complex or Mycobacterium kansasii infection, disseminated or extrapulmonary† •Mycobacterium tuberculosis infection of any site, pulmonary,†§ disseminated,† or extrapulmonary† •Mycobacterium infection, other species or unidentified species, disseminated† or extrapulmonary† •Pneumocystis jiroveci pneumonia† •Pneumonia, recurrent†§ •Progressive multifocal leukoencephalopathy •Salmonella septicemia, recurrent •Toxoplasmosis of brain, onset at age >1 month† •Wasting syndrome attributed to HIV All these are conditions that define what?

AIDS

Acquired Immunodefeciency Syndrome AKA

AIDs

Jay Levy also isolated a virus from AIDS patients in 1984 and called it ____-__________ ___________

AIDs associated retrovirus

HIV Treatment often is organized into three major areas: (1) ___, (2) prophylaxis for _____________ infections, and (3) treatment of HIV-related _______________.

ART opportunistic complications

AIDS associated retrovirus AKA

ARV

In 1984, Jay Levy's team in San Francisco also isolated a retrovirus, AIDS-related virus (___), and designated it as the causative agent for AIDS

ARV

Watson-Crick base pairing of nucleotides in DNA. The __ base pairs form two hydrogen bonds and the __ base pairs form three hydrogen bonds. Thus, __-rich regions are more stable than __-rich regions.

AT, GC, GC, AT

Increased renal sodium reabsoprtion Increased urinary K+ excretion Decreased GFR Decresaed Renal blood flow Increased vascular smooth muscle contraction Increased vascular smooth muscle proliferation Increased myocardium contractility Increased epinepherine release Increased norepinepherine release Effects of which angiotensin recpetor?

AT1

AT1 or AT2: Which increase BP? Which Decrease?

AT1 increases AT2 Decreases

Antithymocyte globulin AKA

ATG

Adenosine Triphosphate AKA

ATP

Adenosine triphosphate AKA

ATP

Significant depletion of ___ has widespread effects on many critical cellular systems

ATP

___ is a high-energy product of metabolism and is often described as the 'energy currency' of the cell

ATP

ATP is transported to the cytoplasm through an ___-___ _____________ in the mitochondrial inner membrane

ATP ADP Translocase

The ___-________ __________ transporters comprise the fourth active transporter family.

ATP binding cassette

ATP depletion → failure of energy-dependent cellular functions → ultimately, necrosis; under some conditions, leakage of mitochondrial proteins that cause apoptosis This is a result of what?

ATP depletion

failure of energy-dependent functions → reversible injury → necrosis This is a result of what?

ATP depletion

Low ATP: Failure of ___-dependent ____ pumps leads to influx of Ca2+, with damaging effects on numerous clelular components

ATP, Ca2+

The most important biochemical abnormality in hypoxic cells that leads to cell injury is reduced intracellular generation of ___, as a consequence of reduced supply of _________.

ATP, oxygen

Low ATP: The activity of plasma membrane ___-dependent ______ pumps is reduced, resulting in intracellular accumulation of sodium and efflux of potassium. The net gain of solute is accompanied by iso-osmotic gain of water, causing cell swelling and dilation of the ER.

ATP, sodium

ABC AKA

ATP-binding cassette

Primary active transport is catalyzed by pump ________ that use energy produced by ___ hydrolysis.

ATPases, ATP

Azidothymidine AKA

AZT

Trypanosoma gambiense Caused by what type of pathogen?

Extracellular protazoa

____________-____ __________ (___) proteins (_____-____, _____) on C albicans mediate attachment to a variety of surfaces, including endothelial and epithelial cells as well as abiotic surfaces such as plastic, and contribute to biofilm formation.

Agglutinin like proteins, Als, Als1, Als7, Als9

Tongue tie AKA

Akyloglossia

____________ and ___________ together control the handling of sodium and water

Aldosterone, vasopressin

Renin catalyzes what reaction?

Angiotensinogen to angiotensin I

Syphilis What bacteria?

Treponema pallidum

Hb level, hematocrit, and RBC indices (mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], red blood cell distribution width [RDW], and mean corpuscular hemoglobin concentration [MCHC]) are tests that are used to screen the patient for what condition?

Anemia

______ generally is defined as Hb level less than 12 g/dL for women and less than 13 g/dL for men.

Anemia

Angiotensin I then becomes a substrate for peptidyl-dipeptidase A AKA What?

Angiotensin I then becomes a substrate for peptidyl-dipeptidase A

ACE catalyzes what reaction?

Angiotensin I to angiotensin II

ACE inhibitors block what reaction

Angiotensin I to angiotensin II

Angiotensin receptor blockers block what?

Angiotensin II binding to AT1

Bifid tongue occurs when the right and left portions of the tongue do not merge during development. This is usually seen close to the tip of the tongue in the _________ _/_

Anterior 2, 3

Bacillus anthracis What bioterrorism agent?

Anthrax

Bcl-2 and Bcl-Xl: pro or anti apoptotic?

Anti

Problems with antibiotics in sickle cell patients?

Antibiotic prophylaxis is recommended for major surgical procedures.

Good ways to identify all types of bacteria (3)

Antibodies Culture DNA probes

After bypassing host tissue barriers, infectious microorganisms must also evade host innate and adaptive immunity mechanisms to successfully proliferate and be transmitted to the next host. Strategies include: •_________ variation •Inactivating __________ or ___________ •Resisting ______________ (e.g., by producing a capsule) •Suppressing the host ___________ immune response (e.g., by inhibiting MHC expression and antigen presentation)

Antigenic complement, antibodies phagocytosis adaptive

_________ is the process by which redundant or defective cells are rapidly eliminated in a manner that does not provoke a local inflammatory reaction in the tissue.

Apoptosis

pathway of cell death in which cells activate enzymes that degrade the cells' own nuclear DNA and nuclear and cytoplasmic proteins

Apoptosis

Mechanism of anthrax exotoxin action. The _ __________, also called "protective antigen," binds a cell-surface protein, is cleaved by a host protease, and forms a heptamer. Three _ subunits of _____ factor (__) or ________ factor (__) bind to the _ heptamer, enter the cell, and are released into the cytoplasm. EF binds ________ and ____________ to form an adenylate cyclase that increases intracellular ____, which causes efflux of _____ and interstitial _____. __ is a protease that destroys mitogen-activated protein kinase kinases (______), leading to cell death

B component, 3, edema, EF, lethal, LF, B, calcium, calmodulin, cAMP, water, edema, LF, MAPKKs

In experimental animals, generation of a Th2 response is not protective against _ __________ infection, whereas a Th1 response limits the spread of the infection and enables antifungal therapy to clear the infection.

B dermatidis

Virulent strains of _ __________ shed a component of their cell wall glycoprotein that binds to macrophage receptors, opsonizing antibodies and complement and thereby inhibiting phagocytosis.

B dermatidis

After inhalation, _ __________ undergoes thermal dimorphism from the small conidia into the larger yeast form (8 to 30 μm) that is difficult for neutrophils to phagocytose.

B determaditis

Virulent strains of _ __________ shed a component of the cell wall glycoprotein WI-1, which binds to macrophage receptors and to opsonizing antibodies and complement

B determidiis

Vitamin __ is a mixture of pyridoxine (an alcohol), pyridoxal (an aldehyde), pyridoxamine, and their 5′-phosphate esters.

B6

Vitamin __ is present in a wide variety of foods such as fish, beef, liver, poultry, and also potatoes and fruits (but not citrus fruits).

B6

The function of vitamin ___ needs to be considered together with folate

B12

Vitamin ___ (cobalamin) has a complex ring structure similar to the porphyrin of heme but is hydrogenated to a greater extent.

B12

Vitamin ___ is a cofactor in methionine-associated enzymatic reactions required of protein synthesis and thus in the maturation of RBCs.

B12

Vitamin ___ is only present in animal products

B12

Vitamin ___ is part of the heme structure

B12

Vitamin ___ is required in only one further reaction, that of L-methylmalonyl-CoA mutase, which converts methylmalonyl-CoA to succinyl-CoA.

B12

Vitamin ___ must be supplemented during folate treatment

B12

Vitamin ___ requires the intrinsic factor for its absorption

B12

With the exception of vitamin ___ the body has no storage capacity for water-soluble vitamins.

B12

subacute combined degeneration of the cord, methionine

B12

vitamin ___ may be stored for several years, this form of nutritional deficiency is rare and usually does not develop until late adulthood.

B12

Intrinsic factor failure Which vitamin defeciency? How long does it take to develop?

B12 1-4 years

Vegan diet Which vitamin defeciency? How long does it take to develop?

B12 10-12 years

Ileal dysfunction Which vitamin defeciency? How long does it take to develop?

B12 Rapid!

For the Schilling test, the fasting patient receives a small oral dose of radioactive vitamin ___ and then a larger dose of nonradioactive vitamin ___ as a parenteral flush

B12, B12

Deficiencies of vitamin ___ and _____ ____ are associated with macrocytic anemia and the presence of hypersegmented polymorphonuclear leukocytes in the peripheral blood smear

B12, folic acid

Vitamin ___ and _____ ____ are needed for RBC formation and growth within bone marrow.

B12, folic acid

Patients with nutritional causes of anemia (e.g., vitamin ___ or ____ deficiency) may show loss of papillae from the tongue and atrophic changes in the oral mucosa

B12, iron

Megaloblastic anemia characteristic of vitamin ___ deficiency is probably due to a secondary deficiency of _______ ______, and a consequence of the accumulation of N5-methyltetrahydrofolate.

B12, reduced folate

Decreased levels of what vitamin are observed in alcoholism, obesity, and in malabsorption states (Crohn's disease, celiac disease and ulcerative colitis), as well as in the end-stage renal disease and in autoimmune conditions?

B6

Severe deficiency of what viatamin is also associated with a sideroblastic anemia (anemia characterized by the presence of nucleated red blood cells with iron granules)?

B6

Vitamin __ deficiency causes neurologic symptoms and anemia

B6

HIV infection is highest in what race?

Blacks

The primary fungal pathogens that can infect apparently healthy, immunocompetent hosts and avoid the immune system include what ? (4)

Blastomyces dermatitidis H capsulatum C immitis Paracoccidioides brasiliensis.

Metorrhagia AKA

Bleeding between expected menstrual periods

Whooping cough What bacteria?

Bordetella pertussis

Sharing of needles contaminated with HIV-infected blood is a major route of transmission among injection drug users. Because all blood products in the United States are tested for HIV and other viruses, the risk of transmission via blood transfusions is very low. However, at the beginning of the AIDS epidemic, many individuals receiving clotting factors were exposed to HIV. Clotting factors are now genetically engineered. Health care workers are at risk for transmission from accidental needlestick injuries or from exposure of broken skin and mucosal membranes to infected blood. However, the rate of seroconversion from such incidents is fortunately less than 1 % of those exposed to HIV-positive blood. This may be because the amount of infectious virus in the needle is very small, and larger volumes and repeated exposure are necessary for a significant probability of infection. Nevertheless, extreme care is necessary in handling needles and sharp instruments. Although the virus has been detected in tears, saliva, and urine, these sources have not been demonstrated to be infectious. Breast milk, however, is a source of infection of neonates. Which type of HIV transmission?

Blood

Serum urea AKA Tested along with what?

Blood Urea Nitrogen Creatinine

When cells are deprived of growth factors and other survival signals, or are exposed to agents that damage DNA, or accumulate unacceptable amounts of misfolded proteins, a number of sensors are activated. These sensors are members of the Bcl-2 family called "___ proteins" (because they contain only the ___ of multiple conserved domains of the ___-_ family).

BH3, 3rd, Bcl 2

Brain naturetic peptide AKA

BNP

___ 32 and another peptide, ___ (23 amino acids long), were isolated from the porcine brain, thus the name.

BNP, CNP

Anthrax What bacteria ?

Bacillus anthracis

0.2 to 15 um Obligate intracellular Facultative intracellular Extracellular What type of infectious agent?

Bacteria

Systemic acyclovir, valacyclovir, or famciclovir for at least 5 days can be effective. Higher doses may be needed during severe immunosuppression. An elixir or syrup of diphenhydramine (________) of 12.5 mg/5 mL can be used for pain control. Which HIV periodontal condition>?

Benadryl, Herpes Simplex Virus Infection

converted in the small bowel to all-trans retinal by the action of the β-carotene dioxygenase.

Beta carotene

AIDS is highest in what race?

Black

A 32-year-old man and his 30-year-old wife are referred for a reproductive endocrinologist infertility (REI) consult after 2 years of "trying to get pregnant." He is diagnosed with oligozoospermia. Ejaculated mature sperm are collected and undergo genetic analysis. Using gene linkage analysis, his REI specialist determines that he has aberrations in spermatogenic meiotic recombination, including both diminished frequency and suboptimal location, resulting in high frequency of aneuploid sperm. In explaining the diagnosis, she explains meiosis and recombination attributing the problem to a specific phase of the meiosis. Which part of meiosis is most closely associated with recombination? a. Metaphase I b. Anaphase I/Telophase I c. Prophase I d. Prophase II e. Anaphase II/Telophase II

C

Fully differentiated white adipocytes are large cells, typically having diameters of approximately what size? a. 5 μm b. 10 μm c. 100 μm d. 500 μm e. 1000 μm

C

Ten days after birth a full-term newborn boy develops firm, erythematous nodules and plaques over his trunk, arms, buttocks, thighs, and cheeks. His mother's pregnancy was complicated by placenta previa and his airway was cleared of aspirated meconium immediately after birth. A biopsy of subcutaneous tissue shows necrosis within the brown adipose tissue. What metabolic activity is liable to be affected in this patient? a. Export of fatty acids from fat b. Thermal insulation c. Oxidation of fatty acids for thermogenesis d. Activation of the adenylate cyclase system e. Initiation of shivering

C

What substance, released from the adrenal gland and some autonomic neurons, increases lipolytic activity in white adipocytes? a. Leptin b. Insulin c. Norepinephrine d. Glycogen e. Triglyceride

C

Agglutinin-like sequence (Als) proteins (Als1-Als7, Als9) on _ _________ mediate attachment to a variety of surfaces, including endothelial and epithelial cells as well as abiotic surfaces such as plastic, and contribute to biofilm formation.

C albicans

Antibodies against _ ________ enhance the uptake of the yeast into phagocytes

C albicans

Mannoproteins on the surface of _ ________ act as adhesins that interact with f ibronectin and other components of the extracellular matrix of host cells. .

C albicans

Mannoproteins on the surface of _ ________ act as adhesins that interact with fibronectin and other components of the extracellular matrix of host cells.

C albicans

The yeast-to-hyphal transformation (phenotypic switching) of _ ________ is instrumental in its penetration through epithelial cell surfaces and adaptation to changes in the microenvironment

C albicans

Cystic Fibrosis Transmembrane Conductance Regulator AKA

CFTR

Death receptor pathway of apoptosis AKA

Extrinsic pathway

Plasma membrane Cl− c-AMP-dependent chloride channel, regulation of other channels Which primary active transporter?

CFTR

CF is caused by mutations in the gene ____ which encodes a ___ ________

CFTR, Cl- channel

HIV: the cells most commonly infected are those with ____ receptors, including T helper lymphocytes (____ cells) and _____________.

CD4, CD4+, macrophages

On June 5, 1981, when the Centers for Disease Control (___) reported five cases of ____________ _______ (now ________) pneumonia in young homosexual men in Los Angeles, few suspected that it heralded a pandemic of acquired immunodeficiency syndrome (____).

CDC, Pneumocystis carnii, jiroveci, AIDS

Cyclin Dependent Kinases AKA

CDKs

____ phosphorylate and activate the enzymes and transcription factors whose functions characterize each phase of the cell cycle.

CDKs

Cystic Fibrosis AKA

CF

_______ necrosis. Tuberculosis of the lung, with a large area of caseous necrosis containing yellow-white debris.

Caseous

encountered most often in foci of tuberculous infection. It means "cheese-like," referring to the friable yellow-white appearance of the area of necrosis. On microscopic examination, the necrotic focus appears as a collection of fragmented or lysed cells with an amorphous granular pink appearance in the usual H&E-stained tissue. Unlike with coagulative necrosis, the tissue architecture is completely obliterated and cellular outlines cannot be discerned. The area of caseous necrosis is often enclosed within a distinctive inflammatory border; this appearance is characteristic of a focus of inflammation known as a granuloma

Caseous necrosis

Anthrax: Bacillus anthracis Botulism: Clostridium botulinum toxin Plague: Yersinia pestis Smallpox: Variola major virus Tularemia: Francisella tularensis Viral hemorrhagic fevers: filoviruses (e.g., Ebola, Marburg) and arenaviruses (e.g., Lassa, Machupo) What type of potential agents of bioterrorism?

Category A

Emerging infectious disease threats: Nipah virus, hantavirus, possibly others Nipah virus, hantavirus, possibly others What category of bioterrorism agent?

Category C Diseases and agents

With continuing damage, the injury becomes irreversible, at which time the cell cannot recover and it dies. What process?

Cell death

The result of a progressive decline in the life span and functional capacity of cells.

Cellular aging

the first manifestation of almost all forms of injury to cells, is a reversible alteration that may be difficult to appreciate with the light microscope, but it may be more apparent at the level of the whole organ

Cellular swelling

Decreased levels of B6 are observed in alcoholism, obesity, and in malabsorption states (_____'s disease, ______ disease and __________ _______), as well as in the end-stage renal disease and in autoimmune conditions.

Chron, celiac, ulcerative colitis

Brucellosis: Brucella spp. Epsilon toxin of Clostridium perfringens Food safety threats: Salmonella spp., Escherichia coli O157:H7, Shigella, others Glanders: Burkholderia mallei Melioidosis: Burkholderia pseudomallei Psittacosis: Chlamydia psittaci Q fever: Coxiella burnetii Ricin toxin from castor beans (Ricinus communis) Staphylococcal enterotoxin B Typhus fever: Rickettsia prowazekii Viral encephalitis: alphaviruses (e.g., Venezuelan equine encephalitis, Eastern equine encephalitis, Western equine encephalitis) Water safety threats: Vibrio cholerae, Cryptosporidium parvum, others What class of bioterrorism agent?

Class B

____________ necrosis. A, A wedge-shaped kidney infarct (yellow) with preservation of the outlines. B, Microscopic view of the edge of the infarct, with normal kidney (N) and necrotic cells in the infarct (I). The necrotic cells show preserved outlines with loss of nuclei, and an inflammatory infiltrate is present (difficult to discern at this magnification).

Coagulative

a form of necrosis in which the underlying tissue architecture is preserved for at least several days. The affected tissues take on a firm texture. Presumably the injury denatures not only structural proteins but also enzymes, thereby blocking the proteolysis of the dead cells; as a result, eosinophilic, anucleate cells may persist for days or weeks. Leukocytes are recruited to the site of necrosis, and the dead cells are digested by the action of lysosomal enzymes of the leukocytes. The cellular debris is then removed by phagocytosis. This necrosis is characteristic of infarcts (areas of ischemic necrosis) in all of the solid organs except the brain.

Coagulative necrosis

Vitamin B12 (cobalamin) has a complex ring structure similar to the porphyrin of heme but is hydrogenated to a greater extent. The iron at the center of the heme ring is replaced by a ______ ion (____)

Cobalt, Co3+

Rhinoviruses disease?

Cold

__________ live in a close relationship with their host, whereby the fungi benefits and the host neither benefits nor is harmed

Commensals

Secreted aspartyl proteases degrade host tissue proteins, enabling several Candida species to penetrate __________ _______ barriers.

Connective tissue

Diphtheria what bacteria?

Corynebacterium diphtheriae

F ATPase AKA

Coupling Factor

Prions Abnormal folding of PrPsc causes neuronal cell death What disease?

Cruetzfeld Jakob disease

____________ ___________ can cause systemic mycoses in healthy individuals, but disease is seen more often in immunocompromised patients.

Cryptococcus neoformans

______________ ___________ can cause systemic mycoses in healthy individuals, but disease is seen more often in immunocompromised patients.

Cryptococcus neoformans

Plasma membrane and cytoplasmic vesicles Cu2+ Cu2+ absorption from intestine and excretion from liver Which primary active transporter?

Cu2+ ATPase

Cystic fibrosis transmembrane conductance regulator (CFTR) Loss of CFTR leads to defects in chloride transport What disease?

Cystic fibrosis

the most common potentially lethal autosomal recessive disease of Caucasian populations, affecting 1 in 2500 newborns

Cystic fibrosis

Cytomegalic inclusion disease What virus?

Cytomegalovirus

In a short __ phase the cell prepares for division during mitosis (M).

G2

Hand and foot warmth and tenderness AKA

Dactylitis

Danger zone for hyperkalemia? Danger zone for hypokalemia?

Danger zone for hyperkalemia? Danger zone for hypokalemia?

` Nausea, diarrhea, lipodystrophy Midazolam, triazolam, quinidine interactions Which HIV drug? Which class?

Darunavir Protease inhibitor

The schematic homodimeric structure of the HIV-1 protease and the location of _________ in between the dimers. __________ has a high affinity for the protease and prevents its dimerization. Binding of the inhibitor is favored by the interactions between the apolar residues of the inhibitor and the hydrophobic amino acid side chains. .

Darunavir, darunavir

A male infant at the age of 3 months suffered from recurrent seizures. His cerebrospinal fluid glucose concentrations were low (0.9-1.9 mmol/L; 16-34 mg/dL), and the ratio of CSF to blood glucose ranged from 0.19 to 0.33; the normal value is 0.65. What condition?

Defective glucose transport

High Na+ High urea Mildly elevated creatinine What condition?

Dehydration

Water deficit AKA

Dehydration

•Efavirenz + tenofovir + emtricitabine (Atripla, Bristol-Myers Squibb) •Ritonavir-boosted atazanavir + tenofovir/emtricitabine •Ritonavir-boosted darunavir + tenofovir/emtricitabine •Raltegravir + tenofovir/emtricitabine •Abacavir + zidovudine + lamivudine (Trizivir, GlaxoSmithKline) •Emtricitabine + rilpivirine + tenofovir (Complera, Gilead) •Elvitegravir + cobicistat + emtricitabine + tenofovir (Stribild, Gilead) •Lamivudine + zidovudine (Combivir, GlaxoSmithKline) •Abacavir + lamivudine (Epzicom, GlaxoSmithKline) •Tenofovir + emtricitabine (Truvada, Gilead) What type of anti-HIV drugs?

Drug combinations used in Highly Active Antiretroviral Thearpy

deposition of calcium at sites of cell injury and necrosis

Dystrophic calcification

A 44-year-old African-American woman visits her family physician for a physical examination at the urging of her husband. She has no current complaints and is taking no medications. She is allergic to erythromycin. She works as a software developer and lives with her 52-year-old husband and 12-year-old daughter. She is a nonsmoker and drinks an occasional glass of wine when she and her husband go out to dinner. She is involved in no regular exercise. Her mother is 66 and suffers from type II diabetes, hyperlipidemia, and hypertension and had a myocardial infarction last year. The patient's father died of a stroke last year at the age of 72. On examination, the patient's blood pressure is 155/100 mm Hg, pulse 84, weight 215 lb (increased from 180 lb 3 years ago), and height 5 ft. 7 in. In this patient, during the period of weight gain which one of the following responses would be most likely in her white fat? a. Increased synthesis of growth hormone b. Decreased synthesis of leptin c. Decreased release of leptin to the blood d. Conversion of beige adipocytes to unilocular white adipocytes e. Increased release of norepinephrine from nerve terminals near white adipocytes

E

Mitotic figures visible in a tissue section from the lining of the small intestine are most likely to belong to which of the following categories? a. Terminally differentiated cells b. Partially differentiated cells c. Blood cells d. Stem cells e. Progenitor cells

E

Vitamin _ is a membrane antioxidant

E

What is the most important form of lipid storage in both white and brown adipocytes? a. Free fatty acids b. Cholesterol c. Chylomicrons d. Glycerol e. Triglycerides

E

the parasite _. ____________ causes colonic ulcers and liver abscesses characterized by extensive tissue destruction and liquefactive necrosis without a prominent inflammatory infiltrate

E histolytica

Deficiency of vitamin _ in premature infants causes __________ anemia, thrombocytosis and edema and also __________ neuropathy, myopathy and ataxia

E, hemolytic, peripheral

Progression of the catalytic subunit of Na+ K+ ATPase

E1 E1P E2P E2

Sodium is higher in ECF or ICF? Potassium?

ECF ICF

The enzyme-linked immunosorbent assay (_____) is the screening test for identification of antibodies to HIV.

ELISA

Amiloride-sensitive epithelial Na+ channel (____) is expressed in the aldosterone-sensitive distal nephron.

ENaC

Endoplasmic reticulum AKA

ER

In circumstances in which the accumulation of misfolded proteins overwhelms the adaptations, the result is __ ________, which leads to the activation of caspases and ultimately apoptosis.

ER stress

There are two protein targets associated with the hallmark 'relapse' and 'drug resistance' phenomena seen during chemotherapy: _____ and ___ __________ ____

ERCC1, DNA polymerase beta

Hairy leukoplakia is an asymptomatic, corrugated white lesion of the lateral borders of the tongue due to reactivation and replication of _______-____ _____ (___)

Epstein Barr virus, EBV

Main strucutral difference between ergosterol and cholesterol?

Ergosterol has an extra CH3 group

Most likely manifestation of candidiasis in HIV patient? Least likely?

Erythmatous Hyperplastic

the origin of a disease, including the underlying causes and modifying factors.

Etiology

There are two important terms that students will encounter throughout their study of pathology and medicine. name them!

Etioogy Pathogenesis

What does M protein in G+ bacteria do

Evades immune system

Problems with bleeding in HIV patients?

Excessive bleeding may occur in the patient with untreated or poorly controlled disease as a result of thrombocytopenia, which fortunately is not a common finding.

Streptococcus pneumoniae What tyep of pathogen?

Extracellualr bacteria

sleeping sickness is caused by what pathogen type?

Extracellualr protazoa

Candida albicans What type of pathogen

Extracellular fungi

Thrush is caused by what type of pathogen?

Extracellular fungi

Filariasis caused by what type of pathogen?

Extracellular helminth

Trichinella spiralis what type of pathogen?

Extracellular helminth

Trichinosis caused by what pathogen type?

Extracellular helminth

___ necrosis in acute pancreatitis. The areas of white chalky deposits represent foci of fat necrosis with calcium soap formation (saponification) at sites of lipid breakdown in the mesentery.

Fat

refers to focal areas of fat destruction, typically resulting from release of activated pancreatic lipases into the substance of the pancreas and the peritoneal cavity. This occurs in the calamitous abdominal emergency known as acute pancreatitis. In this disorder, pancreatic enzymes that have leaked out of acinar cells and ducts liquefy the membranes of fat cells in the peritoneum, and lipases split the triglyceride esters contained within fat cells. The released fatty acids combine with calcium to produce grossly visible chalky white areas (fat saponification), which enable the surgeon and the pathologist to identify the lesions. On histologic examination, the foci of necrosis contain shadowy outlines of necrotic fat cells with basophilic calcium deposits, surrounded by an inflammatory reaction.

Fat necrosis

_____ _______ is manifested by the appearance of lipid vacuoles in the cytoplasm.

Fatty change

_____ _______ occurs in hypoxic injury and in various forms of toxic or metabolic injury and is manifested by the appearance of small or large lipid vacuoles in the cytoplasm.

Fatty change

accumulation of free triglycerides in cells, resulting from excessive intake or defective transport (often because of defects in synthesis of transport proteins); manifestation of reversible cell injury

Fatty change

any abnormal accumulation of triglycerides within parenchymal cells

Fatty change

Types of abnormal lipid depsosition (2)

Fatty change Cholesterol deposition

Dietary iron is in the ______ (____) form. It is reduced in the gastrointestinal tract to divalent ____ by ascorbate and a ferrireductase enzyme located in the intestinal brush border. Fe2+ is transported into the cells by a ________ _____ transporter (which also transports most trace metals). The iron pool within the enterocyte is controlled by the iron regulatory proteins

Ferric, Fe3+, Fe2+, divalent metal

a special form of necrosis, visible by light microscopy, usually in immune reactions in which complexes of antigens and antibodies are deposited in the walls of arteries. The deposited immune complexes, together with fibrin that has leaked out of vessels, produce a bright pink and amorphous appearance on H&E preparations called fibrinoid (fibrin-like) by pathologists. The immunologically mediated diseases (e.g., polyarteritis nodosa)

Fibrinoid necrosis

_______ is needed for enzymatic reactions required for the synthesis of purines and pyrimidines of deoxyribonucleic acid (___) and ribonucleic acid (___) and thus for the synthesis of proteins.

Folate

_____ ____ derivatives are important in single carbon transfer reactions. They are necessary for the synthesis of ___

Folic acid

_____ ____ is present in liver, yeast, and green leafy vegetables (spinach) and fruits, including citrus fruits

Folic acid

_____ ____ (pteroyl-L-glutamic acid) exists in a number of derivatives collectively known as _______

Folic acid, folates

Problems with follow-up in sickle cell patient

Follow-up consultation with patient's physician is advised.

Long Terminal Repeat AKA

LTR

2-200 um Extracellular Facultative intracelluar Wht type of pathogen?

Fungi

•Pneumocystis jirovecii pneumonia •Cryptococcosis •Candidiasis •Disseminated histoplasmosis •Disseminated coccidioidomycosis What type of opportunistic infections in AIDS patients?

Fungi

_______________-sensitive Na+-K+-2Cl--symporter (NKCC2) and ___________-sensitive Na+-Cl--cotransporter (NCCT) are localized in thick ascending loop of Henle and distal convoluted tubules, respectively.

Furosemide, thiazide

The conidial cells of C immitis produce an extracellular protease that can break down immunoglobulin Ig_, Ig_, hemoglobin, collagen, and elastin. .

G, A

The __ phase is a period of cell growth that occurs prior to DNA replication.

G1

The __ phase, the longest part of the cell cycle, begins immediately after mitosis and includes all preparations for DNA replication.

G1

When DNA is damaged, the p53 protein accumulates in cells. It first arrests the cell cycle (at the __ phase) to allow the DNA to be repaired before it is replicated

G1

Progress through the cell cycle stages is monitored at checkpoints, including the __ ____________ _____; only when each phase's activities are completed are the cyclins changed to trigger those of the next phase.

G1 restriction point

Following mitosis, the daughter cells either reenter the __ phase or enter a quiescent phase termed __, when growth and replication cease.

G1, G0

Stages of the cell cycle. __ and __ are growth phases that occur before and after DNA synthesis, respectively. DNA replication occurs during the _ phase. Mitosis occurs during the _ phase, producing new daughter cells that can reenter the __ phase

G1, G2, S, M, G1

_________ variations contribute to the development of many complex diseases and can influence the susceptibility of cells to injury by chemicals and other environmental insults.

Genetic

Borriella burgdorferi Nieserria gonnorrhea Trypsanosma spp. Plasmodium spp. What mechanism of genetic variation?

Genetic rearrangement

Influenza virus Rotavirus Mechanism of antigentic variation?

Genetic reassortment

How to identify Leishmaniae, Plasmodium

Gimesia

Burkholderia mallei What biotertrorism agent?

Glanders

_______ at its normal plasma concentration (5 mmol/L; 90 mg/dL) does not contribute significantly to osmolality but it becomes its major determinant when its concentration increases in diabetes (remember the 'osmotic symptoms' in poorly controlled diabetes)

Glucose

Staining peripheral blood smear with methyl or crystal violet, cyanide-ascorbate assay, qualitative (fluorescent spot) test and quantitative test for G-6-PD, reticulocyte count, indirect bilirubin levels Test for what type of anemia? What cell size

Glucose 6 Phosphate Dehydrogenase Defeciency Normocytic

____________ ______________ are a family of enzymes whose major function is to protect cells from oxidative damage. The most abundant member of this family, glutathione peroxidase 1, is found in the cytoplasm of all cells. It catalyzes the breakdown of H2O2 by the reaction 2 ___ + H2O2 → GS-SG + 2 H2O. The intracellular ratio of __________ _______________ to _________ _____________ is a reflection of this enzyme's activity and thus of the cell's ability to catabolize free radicals.

Glutathione peroxidases, GSH, reduced glutathione, oxidized glutathione

Most bacteria How to identify?

Gram stain

_______________ inflammation is a distinctive form of mononuclear inflammation usually evoked by infectious agents that resist eradication (e.g., M. tuberculosis, Histoplasma capsulatum, schistosome eggs) but nevertheless are capable of stimulating strong T cell-mediated immunity.

Granulomatous

Human Immunodefeciency Virus AKA

HIV

___-specific antibodies can be detected rapidly in blood or in oral fluid obtained via swabbing the gums.

HIV

Human Immunodefeciency Virus 1 AKA

HIV 1

Although antiviral drugs inhibit HIV replication or infection, they cannot cure ___/____

HIV AIDS

Risk is increased for cysts of the parotid and lymphoma. Treatment involves antiretroviral therapy ± immune modulators. Associated xerostomia can be managed with sialogogues and saliva substitutes. Which oral HIV condition?

HIV related salivary gland disdase

Human Leukocyte Antigen typing AKA

HLA typing

It can be measured by high-performance liquid chromatography (____). WHat vitamin?

HPLC Folic acid

Human Papillomavirus AKA

HPV

The usual HPV types are found in oral lesions, but some uncommon variants such as ___-_ and ___-__ also are found. Lesions usually are multiple and may be found on any oral mucosal site.

HPV 7, HPV 32

Treatment of choice is surgical removal of the lesion(s). Other treatment modalities include topical podophyllin, interferon, and cryosurgery. Laser ablation and electrocoagulation have been used, but care must be taken because the plume may contain infectious virus. Which oral condition associated with HIV?

HPV infection

In C albicans, the protein _____ regulates morphogenesis, drug resistance, and biofilm formation; _____ is produced in response to phagocytosis by macrophages; and ____ acts as an invasin.

HSP90, HSP78, Ssa1

Herpes Simplex Virus AKA

HSV

The retrovirus ____-_ causes adult T-cell leukemia/lymphoma in a low percentage of infected individuals after a decades-long latency.

HTLV 1

Within a year of this discovery, a team led by Robert Gallo from the National Institutes of Health isolated a retrovirus identified as the human T lymphotropic virus III (____-___) and labeled it as the etiologic agent for AIDS.

HTLV III

Human T-Cell Lymphotropic Virus Type 1 AKA

HTLV-1

Meningitis, upper and lower respiratory tract infections What bactiera?

Haemophilus influenzae

Oral lesion most likely seen in asymptomatic + PGL for HIV patient? Least likely? (2)

Hairy leukoplakia Veneral warts, NUG

Pellagra like dermatitis and and neurological involvement resemble nutritional niacin deficiency. What disease?

Hartnup disease

Urinalysis demonstrated gross hyperaminoaciduria of neutral monoamino-monocarboxylic acids (i.e. alanine, serine, threonine, asparagine, glutamine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan, histidine and citrulline). What disease?

Hartnup disease

Blockade of the hexose monophosphate shunt pathway in persons with G-6-PD deficiency allows accumulation of harmful oxidants within RBCs. These substances, which produce methemoglobin and denatured Hb, precipitate to form _____ ________, which attach to cell membranes. These alterations in cell membranes lead to hemolysis of the cell (____________ anemia).

Heinz bodies, hemolytic

Infection of the stomach by ______________ _______ also causes ulcers and is associated with an increased risk of gastric adenocarcinoma

Helicobacter pylori

3 mm to 10 m Intracellualar Extracellular What type of pathogen?

Helminths

Rhinovirus Streptococcus pneumonia mechanism of antigenic variation?

Large diversity of serotypes

Heinz bodies AKA

Hemoglobin precipiates

_______________, the oxygen-carrying molecule of erythrocytes, consists of _ pairs of ________ chains (i.e., α plus β, δ, or γ) that form a shell around four oxygen-binding ____ groups.

Hemoglobin, 2, globin, heme

___________ anemias are caused by immune attack, extrinsic factors (infection, splenomegaly, drugs, eclampsia), disorders of the RBC membrane (spherocytosis), enzymopathies (glucose-6-phosphate dehydrogenase [G-6-PD] deficiency), and hemoglobinopathies (sickle cell anemia, thalassemia).

Hemolytic

Least common anemai type in clincial practice

Hemolytic anemia

Normocytic anemias caused by Increased destruction of RBCs (3)

Hemolytic anemia SIckle cell anemia Glucose 6 Phosphate Dehydrogenase Defeciciency

________________ granules in liver cells. A, Hematoxylin-eosin-stained section showing golden-brown, finely granular pigment. B, Iron deposits revealed by a special staining process called the ________ _____ reaction.

Hemosiderin Prussian blue

_________________ is a hemoglobin-derived granular pigment that is golden yellow to brown and accumulates in tissues when there is a local or systemic excess of iron. Iron is normally stored within cells in association with the protein _____________, forming ferritin micelles. Hemosiderin pigment represents large aggregates of these ferritin micelles, readily visualized by light and electron microscopy; the iron can be unambiguously identified by the Prussian blue histochemical reaction. Although hemosiderin accumulation is usually pathologic, small amounts of this pigment are normal in the mononuclear phagocytes of the bone marrow, spleen, and liver, where aging red cells are normally degraded. Excessive deposition of hemosiderin, called _________________, and more extensive accumulations of iron seen in ___________ __________________

Hemosiderin, apoferretin, hemosiderosis, hereditary hemochromatosis

Immunocompetent persons and HIV-infected patients experience about the same rate of recurrent infection (10-15%), but in HIV-infected patients, the lesions are more widespread, occur in an atypical pattern, and may persist for months. Which HIV periodontal condition?

Herpes Simplex Virus Infection

Oral herpes ("cold sore") What virus?

Herpes simplex virus A

Genital herpes What virus?

Herpex simplex virus 2

High or low ECF osmolality leads to cell dehydration? What about cellular edema?

High Low

HIV Influenza virus Mechanism of antigenic variation

High mutation rate

Antiretroviral drugs are currently given as a combination, called ______ ______ _____________ _______, because the likelihood of the development of drug resistance is lower and the blood levels of HIV can be reduced to undetectable levels

Highly Active Antiretroviral Threapy

The mutagenicity of a compound is scored by counting the number of colonies that have grown, i.e. reverted to the ____ phenotype in an Ames Test

His+

Some fungi, including ___________ _____________ and ___________ ________, cause systemic mycoses that start with infection of the lungs and then spread to other parts of the body.

Histoplasma capsulatum, Cocciolites immitus

The treatment of choice for disseminated infection is intravenous amphotericin B. Oral itraconazole also has been found to be effective and has fewer adverse effects, with better patient compliance. Which HIV oral condition?

Histoplasmosis

the most common endemic respiratory fungal infection in the United States and usually is subclinical and self-limiting. Dissemination of infection occurs in about 5% of patients with AIDS who live in areas in the United States where the fungus is endemic. Which oral condition with HIV?

Histoplasmosis

Normal cell is in what process?

Homeostasis

results in a profound weakening of the immune system that makes the patient susceptible to a range of bacterial, fungal, protozoal and viral superinfections. What infection?

Human Immunodefeciency Virus

The AIDS virus was later designated as _____ _________________ ______ _

Human Immunodefeciency Virus 1

_____ __________________ _____ _ is the etiologic agent of acquired immunodeficiency syndrome (AIDS), currently designated as HIV/AIDS.

Human Immunodefeciency Virus 1

Melanin pigmentation has been reported to occur in HIV-infected patients. Several of the medications (ketoconazole, clofazimine, and zidovudine) used to treat these patients may cause melanin pigmentation. Addison-like pigmentation also may occur because of destruction of the adrenal gland. HIV infection itself may cause melanin pigmentation. Which oral HIV condition?

Hyperpigmentation

increased cell numbers in response to hormones and other growth factors; occurs in tissues whose cells are able to divide or contain abundant tissue stem cells

Hyperplasia

_______, or oxygen deficiency, interferes with aerobic oxidative respiration and is an extremely important and common cause of cell injury and death

Hypoxia

The main body water compartments are the intracellular fluid (___) and the extracellular fluid (___). ___ includes interstitial fluid and plasma. The gradient of sodium and potassium concentrations is maintained across cell membranes by the ___/__-______. ________ is a major contributor to the osmolality of the ECF, and a determinant of the distribution of water between ECF and ICF. Distribution of water between plasma and interstitial fluid is determined by the oncotic pressure exerted by ______ ________

ICF, ECF, ECF, Na+ K+ ATPase, Sodium, plasma proteins

Activation of naïve Τ cells along the Th1 pathway results in the production of ___-_____, IL-_, IL-__, and IL-__ that stimulate phagocytosis and the production of __________ _____ _ cells and opsonizing __________, resulting in a protective effect against fungal infections.

IFN gamma, 2, 12, 18, cytotoxic CD8+ T, antibodies

Prothrombin (factor __) contains 10 carboxylated residues and all are required for this protein's specific chelation of ____ ions during its function in the ___________ process.

II, Ca2+, chelation

Vitamin K is required for post-translational modification of coagulation factors (factors __, ___, __, and _)

II, VII, IX, X

Immune Reconstituition Inflammatory Syndrome AKA

IRIS

may affect plasma membrane, lysosomal membranes, mitochondrial membranes; typically culminates in necrosis result of what?

Increased permeabiluty of plasma membranes

Diarrhea Quinidine interaction Which HIV drug? Which class?

Indinavir protease inhibitor

Ulceration AKA

Infection

Diseases caused by microbes involve an interplay of microbial virulence and host responses: ○___________ agents can cause cell death or dysfunction by directly interacting with the cell. ○Injury may be due to local or systemic release of ____________ products, including ___________ (LPS), exotoxins, or superantigens. ○Pathogens can induce ________ responses that cause _______ damage. Absence of an immune response may reduce the damage induced by some infections; conversely, immunocompromise can allow uncontrolled expansion of _________________ agents or of microorganisms that can directly cause injury.

Infectious bacterial, endotoxin immune, tissue, opportunistic

Influenza What virus?

Influenzavirus A and B

•Raltegravir (Isentress, Merck) •Dolutegravir (Tivicay, GlaxoSmithKline) What class of anti-HIV drugs?

Integrase Inhibitors

HTLV-1: Tax also causes an increase in the production of ____________-_ and __-_ receptor, causing uncontrolled growth.

Interleukin 2, IL2

Mitochondrial pathway of apoptosis AKA

Intrinsic

Enteropathogenic E. coli, Shigella spp., Vibrio cholerae Invasive or noninvasive gastroenterocolitis Campylobacter jejuni, Campylobacter coli Yersinia enterocolitica Salmonella spp. All cauyse what diseases (2)?

Invasive or noninvasive gastroenterocolitis

loss of ATP leads to the failure of many energy-dependent cellular systems, including (1) ___ _________ (leading to cell swelling, and influx of Ca2+, with its deleterious consequences); (2) depletion of _____________ stores and accumulation of _______ ______, thus ____________ the intracellular pH; and (3) reduction in _________ synthesis.

Ion pumps glyucogen, lactic acid, decreased protein

____ is important in the transfer of molecular oxygen

Iron

Serum iron, ferritin, total iron-binding capacity (TIBC), transferrin saturation, bone marrow aspirate; also, stool examination for occult blood Tests for which type of anemia? What cell size is this?

Iron defeciency Microcytic

30% to 60% of persons with rheumatoid arthritis (who more commonly are women) have this type of anemia.

Iron defeciency anemia

Microcytic anemia Caused by decreased production of RBCs Which anemia type?

Iron defeciency anemia

Ferrous sulfate, ferrous fumarate, ferrous gluconate Examples of what?

Iron supplements

The binding of sulfonylureas such as tolbutamide and glibenclamide to ____-____ on the outside of the plasma membrane is thought to mimic the regulatory effect of intracellular ATP.

KATP beta

Defective ____ channels, which are unable to transport __, induce low blood glucose concentration - a condition called Persistent Hyperinsulinemic Hypoglycemia of Infancy (____) that occurs in 1 per 50,000 persons - as a result of loss of __-channel function and continuous insulin secretion.

KATP, K+, PHHI, K+

The ATP-sensitive K+ channel (_____) participates in regulation of insulin secretion in pancreatic islet ____-cells.

KATP, beta

Kaposi Sarcoma AKA

KS

Human herpes virus type 8 (___-_) involved in this development. About 50% of patients with this have oral lesions, and the oral cavity is the initial site of involvement in 20% to 25% of cases. The most common sites are the hard palate, gingival, and tongue. It that occurs in an HIV-infected patient is diagnostic of AIDS. Which condition of periodontium associated with HIV?

Kaposi Sarcoma

Often regresses with HAART. Treatment involves irradiation, local and systemic chemotherapy. Focal symptomatic lesions can be excised, or injected with vinblastine or a sclerosing agent (sodium tetradecyl sulfate). Other options for dealing with these types of lesions are cryotherapy, laser ablation, and electrosurgery, but care must be taken to protect operating personnel from aerosolization of viral particles when the laser or electrosurgery unit is used. Which HIV periodontal condition?

Kaposi Sarcoma

Human immunodeficiency virus (HIV) infection results in a profound weakening of the immune system that makes the patient susceptible to a range of bacterial, fungal, protozoal and viral superinfections. _______ ________ may also develop; it is a cancer-like disease of blood vessels caused by infection with human herpesvirus-8 (HHV-8).

Kaposi's sarcoma

Found in about 3% of patients with AIDS. Most are found in extranodal locations. Most lesions are non-Hodgkin B cell lymphoma and are related to the EBV. The CNS is the most common site, but oral lesions occur in the palate and gingiva and in other locations. Which oral HIV complication?

Lymphoma

Treatment usually involves a combination of chemotherapy and radiation and is used for local control of disease. Prognosis is very poor, with death occurring within months of the diagnosis. HAART has reduced the prevalence of opportunistic infections and Kaposi sarcoma in HIV-infected patients but has not affected the prevalence of lymphoma. Which oral HIV condition?

Lymphoma

HIV: Early in the infection of a person, this co-receptor is the chemokine receptor CCR5, expressed primarily on macrophages and dendritic cells. Thus, the virus is initially "_-_______" or an "__ virus."

M tropic, R5

_. _____________ causes constrictive fibrous pericarditis

M tuberculosis

Actions of angiotensin (1-7), which acts through the ___ receptor (it may also bind to ___ and ___), also seem to be _______________

MAS, AT1, AT2, cardioprotective

Macrocytic anemia size of RBC

MCV > 100 fL

Hb level, hematocrit, and RBC indices (mean corpuscular volume [___], mean corpuscular hemoglobin [___], red blood cell distribution width [___], and mean corpuscular hemoglobin concentration [_____]) are tests that are used to screen the patient.

MCV, MCH, RDW, MCHC

Microcytic anemia RBC size

MCV: < or = 80 fL

Major Histocompatibility Complex AKA

MHC

CTLs secrete chemokines such as RANTES, ___-______, and ___-_____ that bind the chemokine co-receptors for HIV, thereby restricting HIV entry and replication

MIP 1alpha, MIP 1beta

Pathwasys of apoptosis (2)

MItochondrial Death receptor

Plasma membrane Glutathione conjugate Detoxification, multidrug resistance Which primary active transporter?

MRP

Recently, a mammalian protein, ____, was characterized that specifically degrades 8-oxo-dGTP, thereby preventing misincorporation of this altered nucleotide into DNA. Gene targeting was used to develop an ____ knockout mouse. Compared to the wild-type animal, the knockout showed a _______ number of tumors in lung, liver, and stomach, illustrating the importance of this (and other) __________ protection mechanisms.

MTH1, MTH1, increased, postrepair

Neonates with an excessively large tongue (________________) can have major problems with breathing and feeding.

Macroglossia

functions as cofactor for many enzymes and is also important in the maintenance of membrane electrical potential What mineral?

Magnesium

pityriasis versicolor is a skin discoloration and scaling caused by ___________ ______

Malassezia furfur

How is HIV transmitted most often?

Male to Male Sexual contact

How are most cases of AIDS acquired?

Male to male sex

•Kaposi sarcoma (human herpesvirus 8) •Lymphoma What type fo conditions asosoicated with AIDS patients?

Malignancies

Measles (rubeola) What virus?

Measels virus

Single base pair alterations also include depurination. The purine-_-__________ bonds are especially labile, so that an estimated 3-7 purines are removed from DNA per min per cell.

N glycosidic

Those nucleotides that contain amines, cytosine and adenosine, may spontaneously deaminate to form uracil or hypoxanthine, respectively. When these bases are found in DNA, specific _-____________ remove them.

N glycosylases

The sizes of lesions can vary from tiny microabscesses formed by bacteria seeding from an infected heart valve, to distended, pus-filled fallopian tubes caused by _. ____________, to diffuse involvement of the meninges during _. ____________ infection, to entire lobes of the lung during pneumonia.

N gonnorrhea, H influenzae

The remainder of the proteins that are found in mitochondria (about 1000) are produced from nuclear genes, synthesized in the cytoplasm on 'free' ribosomes, then imported into the mitochondrion. This import process requires a special _-terminal ____________-______ sequence of about 25 amino acids in length that forms an amphipathic helix which interacts with transporter and chaperone proteins in the inner and outer mitochondrial membrane and matrix.

N, mitochondrial import

Nitrous Oxide-Oxygen AKAA

N2O-O2

Niacin is required for ____ and _____ synthesis

NAD+, NADP+

In humans, the mitochondrial genome encodes 22 tRNAs, two rRNAs, and 13 mitochondrial proteins that are involved in the respiratory apparatus, including subunits of ____ dehydrogenase, __________ _, _____________ oxidase and ATPase.

NADH, cytochrome b, cytochrome

The byproduct of the hexose monophosphate shunt pathway is _____, which is used to reduce various cellular oxidants

NADPH

Furosemide-sensitive Na+-K+-2Cl--symporter (_____) and thiazide-sensitive Na+-Cl--cotransporter (____) are localized in thick ascending loop of Henle and distal convoluted tubules, respectively.

NCC2, NCC

Na+/H+-antiporter (____) mediates Na+ entry in the proximal tubule

NHE3

Natural Cytotoxic Cells AKA

NK cells

Natural Killer cells AKA

NK cells

Non-Nucleoside Reverse Transcriptase Inhibitors AKA

NNRTIs

Nitric Oxide AKA

NO

The most important ions in plasma are ___, __, ____, ___, _____, and _____. ____, in a concentration close to 0.9% (thus 'physiologic saline'), is the main ionic component of the extracellular fluid. __ is the main intracellular cation. Glucose and urea also contribute to plasma osmolality. Their contribution is normally small, because they are present in plasma in relatively ___ molar concentrations (about 5 mmol/L each). However, when glucose concentration _________ in diabetes, its contribution to osmolality becomes significant. Plasma ____ increases in renal failure but it does not contribute to water movement between ECF and ICF because it freely crosses ____ __________. The main intracellular cation is __ and the main anions are __________ and ________. There is also a substantial amount of ____ in cells.

Na+, K+, Ca2+, Cl-, PO42-, HCO3-, NaCl, Na+, low, increases, urea, cell membranes, K+, phosphates, proteins, Mg2+

Interactions between DNA and mobile cations, such as ___, ____, and the polyamines such as spermidine, play an important role in the physical properties and biological function of DNA

Na+, Mg2+

The kidney is a major site for regulation of ___ homeostasis; several transport systems participate in ___ handling in the kidney tubules

Na+, Na+

Segment-specific expression of renal Na+ transport proteins. Various ___ transport proteins expressed in the apical membranes of renal epithelial cells transport ___from the urine into the cells. Na+ in the cells is excreted into the blood by an ___/__ ______ expressed in the ______________ membranes. __ ions are recycled through basolateral _____ in the _____ __________ _____ of Henle and ____________ sensitive _______ nephron. Chloride ions leaves the cells in the _____ ________ ____ of ______ and _______ ___________ _________ through ____.

Na+, Na+, Na+ K+ ATPase, basolateal, Cl-, ROMK, thick ascending loop, aldosterone, distal, thick ascending limb, aldosterone, distal, thick ascending loop, henle, distal convoluted tubule, ClC's

Aldosterone promotes renal ___ and water retention and elevated blood pressure by increasing ___ reabsorption in the cortical ___________ ____

Na+, Na+, collecting duct

Most important ion pump

Na+-K+ ATPase

Transport protein located in the renal basolateral membrane of epithelial cells transports Na+ across the membrane into the blood and generates a low intracellular Na+ concentration

Na+/K+ ATPase

Types of cell death (2)

Necrosis Apoptosis

________ cells may persist for some time or may be digested by enzymes and disappear. Dead cells may be replaced by myelin figures, which are either phagocytosed by other cells or further degraded into fatty acids. These fatty acids bind calcium salts, which may result in the dead cells ultimately becoming calcified.

Necrotic

May be seen as an extension of NUP or may involve oral mucosa separate from the gingiva. Which HIV periodontal condition?

Necrotizing Stomatitis

Relates to ulceration and necrosis of one or more interdental papillae with no loss of periodontal attachment. Which periodontal HIV condition?

Necrotizing Ulcerative Gingivitis

consists of gingival ulceration and necrosis with attachment loss and does not respond to conventional periodontal therapy. Which HIV periodontal condition?

Necrotizing Ulcerative Periodontitis

HIV: downregulates cellular CD4 and MHC class I proteins.

Nef

Meningitis What bacteria?

Neisseria meningitidis (meningococcus)

Paresthesias Ergotamine Which HIV drug? Which class?

Nelfinavir Protease inhibitor

In normal (immunocompetent) persons, the patterns of host responses are fairly stereotypical for different classes of microbes; these response patterns can be used to infer possible causal organisms. ○___________-rich acute suppurative inflammation is typical of infections with many bacteria ("pyogenic" bacteria) and some fungi. ○_________ cell infiltrates are common in many chronic infections and some acute viral infections. ○______________ inflammation is the hallmark of infection with Mycobacterium tuberculosis and certain fungi. ○_________ and _______________ lesions are caused by some viruses. ○Chronic _____________ and _________ represent the final common pathway of many infections.

Neutrophil Mononuclear Granulomatous Cytopathic, proliferative inflammation, scarring

____________ can more readily digest P brasiliensis strains that lack the α-(1,3)-glucan

Neutrophils

______ is active as part of the coenzyme nicotinamide adenine dinucleotide (____) and nicotinamide adenine dinucleotide phosphate (_____), both of which participate in ______________-catalyzed reactions

Niacin, NAD+, NADP+, nicotinamide

Nocardiosis What bacteria?

Nocardia asteroides*

•Nevirapine (Viramune, Boehringer Ingelheim) •Efavirenz (Sustiva, Bristol-Myers Squibb) •Etravirene (Intelence, Janssen) •Rilpivirine (Edurant, Janssen) •Delavirdine (Rescriptor, Pfizer) Which class of anti-HIV drug?

Non-Nucleoside Reverese Transcriptase Inhibitors

Problems with allergy in HIV patients?

None

Problems with anesthesia in HIV patients?

None

Problems with anxiety in HIV patients?

None

Problems with anxiety in sickel cell patients

None

Problems with bleeding in sickel cell patients

None

Problems with blood pressure in HIV patients?

None

Problems with blood pressure in sickel cell patients

None

Problems with breathing in sickel cell patients

None

Problems with chair position in HIV patients?

None

Problems with chair position in sickle cell patients

None

Problems with devices in Sickle cell patient

None

Problems with equipment in HIV paitents?

None

Problems with follow-up in HIV patients?

None

Which stomach cells have H+ K+ ATPase?

Parietal cells

refers to the steps in the development of disease

Pathogenesis

__________ adaptations are responses to stress that allow cells to modulate their structure and function and thus escape injury. Such adaptations can take several distinct forms.

Pathologic

Disease AKA (2)

Pathos, suffering

How to identify fungi, amebae?

Periodic acid-Schiff

____________ anemia is caused by a deficiency of intrinsic factor, a substance secreted by the stomach parietal cells that is necessary for absorption of vitamin B12

Pernicious

Macrocytic anemias caused by Decreased production of RBCs (3)

Pernicious anemia Folate defeciency Hypothyroidism

CBC, serum vitamin B12 (cobalamin) assay levels, Schilling test, serum antiparietal cell, and intrinsic factor antibodies tests for what type of anemia What cell size?

Pernicious anemia Macrocytic

Usually not treated directly, may need biopsy to rule out lymphoma or other conditions. What HIV oral condition?

Persistent generaized lymphadenopathy

The schema of tongue primordia. (a) The ventral wall of the ________ in the ___ week of intra-uterine life. (b) The developing tongue at the 5th month. Numbers 1-4 indicate the positions of the _________ _______. _ swellings are seen: _ distal tongue buds (________ __________ _____________), the median tongue bud (__________ ______) and the ____________ ___________

Pharynx, 4th, pharyngeal arches, 4, 2, lateral lingual swellings, tuberculum impar, hypophyarngeal eminence

P-ATPase AKA

Phosphorlyation

______________ adaptations usually represent responses of cells to normal stimulation by hormones or endogenous chemical mediators (e.g., the hormone-induced enlargement of the breast and uterus during pregnancy)

Physiologic

Protein concentration higher in plasma or ECF?

PlASMA

yersinia pestis What bioterrorism agent?

Plague

The hemoglobinopathies are more commonly found in regions of malarial endemicity and in populations who have migrated from these regions, because the mutated gene(s) confer advantages against infection by __________ ____________

Plasmodium falciparium

____________ of HIV infection requires a number of approaches: • Educating the population as to how HIV is transmitted and explaining prevention measures, such as the practicing of safe sex, the proper use of condoms, monogamous relationships, and not sharing or reusing needles. • Screening blood, blood products, and organs for HIV. • Infection-control measures, including universal precautions based on the assumption that all patients are infectious for HIV. These include wearing protective gloves, mask and gown, and other barriers to prevent exposure to blood products. Contaminated surfaces should be disinfected with 10% household bleach, 70% ethanol or iso-propanol, 2% glutaraldehyde, and 4% formaldehyde (or _% _________ _________). • Use of contraceptive creams with anti-HIV drugs and male circumcision. These procedures only reduce the risk of infection.

Prevention 6, hydrogen peroxide

_______ _______ transport systems use ATP to drive ion pumps (ion transporting ATPases or pump ATPases)

Primary active

_______ ________ transport is catalyzed by pump ATPases that use energy produced by ATP hydrolysis.

Primary active

________ _______ transport systems use ATP directly to drive transport; ____________ _______ transport uses an electrochemical gradient of Na+ or H+ ions, or a membrane potential produced by primary active transport processes

Primary active, seocndary active

<20 nm Intracellular What type of pathogen?

Prion

Cruzefeldt Jacob disease caused by what infectious agent type?

Prion

prion example

Prion protein

Problems with antibiotics in HIV patients?

Prophylactic use not required unless severe immune neutropenia (<500 cells/µL) is present. Manage postoperative infections with usual antibiotic use. Check for drug interactions before use of antibiotics.

_____________ levels may be increased by ritonavir which may potentially lead to toxic effects such as drowsiness, slurred speech, or incoordination

Propoxyphene

1-50 um Extracellular Obligate intracellular Facultative intracellular What type of pathogen?

Protazoa

Supprative inflammation AKA

Purulent inflammation

Red blood cells AKA

RBCs

A reticulocyte count (based on percentage of ____) of less than ___% indicates inadequate RBC production in the bone marrow, whereas a value greater than ___% indicates increased production in response to bleeding or destruction.

RBCs, 0.5, 1.5

Fatigue St. Jon's wort interaction Which HIV drug? Which class?

Ritonavir Protease inhibitor

In early stages or mild forms of injury the functional and morphologic changes are reversible if the damaging stimulus is removed. At this stage, although there may be significant structural and functional abnormalities, the injury has typically not progressed to severe membrane damage and nuclear dissolution. What process?

Rev ersible Cell Injury

HIV: Rev promotes the transport of unspliced mRNA into the cytoplasm. Only Rev, Tat, and Nef are synthesized from fully spliced mRNA. The RNAs encoding the other genes are not spliced and hence would not normally be transported into the cytoplasm. Thus, Rev plays a crucial role in the production of viral proteins by binding to the ___-__________ _______ in the env region of the viral RNA and transporting the latter into the cytoplasm.

Rev responsive element

cell swelling, fatty change, plasma membrane blebbing and loss of microvilli, mitochondrial swelling, dilation of the ER, eosinophilia (due to decreased cytoplasmic RNA)

Reversible cell injury

Upper respiratory tract infection What virus?

Rhinovirus

the predominant cell wall polysaccharides in Zygomycetes (________ and _____) are chitin and chitosan, whereas those in Ascomycetes (_____________, ________, ____________, and ______________) are β-glucans and mannans, and those in Basidiomycetes (______________) are chitin and mannans.

Rhizopus, Mucor, Aspergillus, Candida, Histoplasma, Coccioides, Cryptococcus

Bioterrorism agent: _____ toxin from _______ beans (Ricinus communis)

Ricin, castor

characterized by soft pliable bones due to defective mineralization secondary to calcium deficiency. What disease?

Ricket's

Aging atrophy AKA

Senile atorophy

Types of mold hyphae (4)

Septal Hyphae with arthoconidia Coencytic Septate with clamp connections

the profile commonly requested by a physician includes sodium, potassium, chloride and bicarbonate concentrations. What test?

Serum electrolyte concentrations

Among adults, HIV is transmitted most commonly via sexual intercourse with an infected partner. The virus can penetrate the epithelial layers of the vagina, vulva, penis, or rectum. The risk of transmission is increased by factors that may damage the epithelia, especially other sexually transmitted infections that cause ulcers or inflammation. The virus can traverse the vaginal mucosa and interact with dendritic projections of Langerhans cells and infect macrophages, dendritic cells, and helper T lymphocytes in the submucosal layers. Dendritic cells in the mucosa may bind to and carry the virus from the site of infection to the local lymph nodes, where other cells may become infected. The DC-SIGN molecule on the surface of dendritic cells may be involved in this transmission process. Which type of HIV transmission?

Sexual

Major routes of HIV transmission (3)

Sexual Blood Vertical

Sickledex, high-performance liquid chromatography, hemoglobin electrophoresis, reticulocyte count, indirect bilirubin level Test for waht type of anemia? What cell size?

Sickel cell anemia Normocytic

______ ____ _____ is the heterozygous state in which the affected person carries one gene for HbS.

Sickle cell trait

All African American patients should be questioned about the presence of sickle cell disease in their family histories. If the patient or family members have not been screened, the dentist should arrange for the patient to be tested. This can be done in the dental office with the _________ test (Streck, Inc., Omaha, Nebraska), in a commercial clinical laboratory, or by a physician

Sickledex

Sickle cell: Diagnosis requires use of RBC indices and tests in which deoxygenating agents are used (___________).

Sickledex

Fungi, legionellae, Pneumocystis How to identify?

Silver stain

Digestion, absorption and transport of vitamin B12: ______ _________ of free vitamin B12 across the intestinal membrane accounts for 3% of transported vitamin, and complexing with __________ ______ (__) accounts for 97%. Vitamin B12 derivatives are released from food by peptic digestion in the stomach and bind to __ secreted by the ________ cells of the gastric mucosa. The IF-B12 complex binds to specific receptor sites on the _____ mucosa. The rate-limiting factor for vitamin B12 absorption is the number of _____ _________ sites. Other transport proteins, ______________ _, __ and ___ (TC I, II and III) and _-proteins, are involved in the delivery or storage of the cobalamins. The latter are secreted by the ________ glands and ________ mucosa.

Simple diffusion, intrinsic factor, IF IF, parietal ileal receptor binding Transcobalamin I, II, III, R, salivary, gastric

Subcutaneous mycoses are caused by trauma to the skin, involve the deeper skin layers, and include lymphocutaneous sporotrichosis (caused by ___________ __________).

Sporothrix schenckii

Fatty change aKA

Steatosis

____ _____ occur in all tissues with rapid cell turnover; they divide slowly in an asymmetric manner, with one daughter cell remaining a stem cell and one becoming committed toward differentiation.

Stem cells

Lobar pneumonia, meningitis What bacteria?

Streptococcus pneumoniae (pneumococcus)

In the absence of appropriate _ cell-mediated immunity, granulomatous host response does not occur. Mycobacterium avium infection in a patient with AIDS, showing massive intracellular ____________ infection with ____-____ organisms (filamentous and pink in this acid-fast stain preparation). The intracellular bacteria persist and even proliferate within _____________, because there are inadequate _ cells to mount a ______________ response.

T, macrophage, acid fast, acid fast, macrophages, T, granulomatous

Total Iron Binding Capacity AKA

TIBC

HIV: The transmembrane glycoprotein (__) ____ undergoes a conformational change and inserts its hydrophobic N-terminus into the host cell membrane and facilitates membrane fusion.

TM gp41

Tumor Necorsis Factor AKA

TNF

Target of Rapamycin AKA

TOR

Among the biochemical alterations that have been described as playing a role in counteracting the aging process are reduced signaling by insulin-like growth factor receptors, reduced activation of kinases (notably ___ and ___ _______), and altered transcriptional activity.

TOR, AKT kinase

Repeated sequence of a telomere

TTAGGG

Thymine Triphopshate AKA

TTP

HIV: transcriptional activator that acts at a site (TAR) near the onset of mRNA transcription by recruiting cellular proteins to the RNA polymerase and enabling the complete transcription of the HIV genome.

Tat

HIV gene expression is regulated by six gene products called auxiliary proteins or accessory gene products: ___ is a transcriptional activator that acts at a site (___) near the onset of mRNA transcription by recruiting cellular proteins to the RNA polymerase and enabling the complete transcription of the HIV genome. ___ promotes the transport of unspliced mRNA into the cytoplasm. Only Rev, Tat, and Nef are synthesized from fully spliced mRNA. The RNAs encoding the other genes are not spliced and hence would not normally be transported into the cytoplasm. Thus, Rev plays a crucial role in the production of viral proteins by binding to the Rev-responsive element in the env region of the viral RNA and transporting the latter into the cytoplasm. ___ downregulates cellular CD4 and MHC class I proteins. ___ increases the ability of HIV to infect primary T cells and some nonpermissive cells in culture. Vif inhibits APOBEC-3G, a cellular RNA-editing enzyme that hypermutates the HIV genome. ___ complexes with CD4 in the endoplasmic reticulum to enable the newly synthesized gp120 to reach the plasma membrane and mediates the release of the virus at the plasma membrane. ___ is essential for virus replication in nondividing cells like macrophages and enables the viral DNA to reach the nucleus.

Tat, TAR Rev Nef Vif Vpu Vpr

N5MeTHF is converted to what during homocysteine conversion to methionine?

Tetrahydrofolate

The function of vitamin B12 needs to be considered together with ______

folate

C albicans binding to complement can inhibit ____________

phagocytosis

________ depletion can occur quickly (within approximately 14 days), Early symptoms are loss of appetite, constipation and nausea

Thiamine

Platelet counts below 50,000/mm3 may result in significant bleeding with minor surgical procedures. Platelet replacement may be indicated for these patients Which oral HIV condition?

Thrombocytopenia

found in about 10% of HIV-infected patients. It may occur during any stage of the disease. Skin manifestations are most common, but petechiae, ecchymosis, and spontaneous gingival bleeding can occur in the oral cavity. Which oral HIV condition?

Thrombocytopenia

Comparison of the transport kinetics of facilitated diffusion and simple diffusion. The rate of transport of substrate is plotted against the concentration of substrate in the extracellular medium. In common with enzyme catalysis, transporter-catalyzed uptake has a maximum transport rate, ____ (_______________). __ is the concentration at which the rate of substrate uptake is half-maximal. For simple diffusion, the transport rate is ________ and __________ proportional to _____________ concentration.

Tmax, saturable, Kt, slower, directly, substrate

Should the lingual frenulum on the ventral surface of the tongue extend from the sublingual papilla and across the floor of the mouth, there may what condition?

Tongue tie

Chemical Injury AKA

Toxic injury

Problems with emergencies in sickle cell patient

Treat acute infection with incision and drainage if indicated; local heat and high doses of appropriate antibiotics will help avoid a crisis. Dehydration should be avoided. If sickling crisis occurs, hospitalization is indicated.

Ca2+ movement in muscle contraction cycle. Roles of transporters in Ca2+ movements in skeletal and cardiac muscle cells during contraction. In skeletal muscle, _____ directly activate release of Ca2+ from the ____________ ____________. The increased cytoplasmic Ca2+ concentration triggers muscle contraction. A ____ __________ in the sarcoplasmic reticulum pumps Ca2+ back into the lumen, _____________ the cytoplasmic Ca2+ concentration, and the muscle relaxes. In heart muscle, _____ allow entry of a small amount of Ca2+, which induces release of Ca2+ from the lumen of _________ ________________. Two types of ____ _________ and an ____/____ _________ are responsible for pumping cytoplasmic Ca2+ out of the muscle cell. The Na+/Ca2+-antiporter uses the ________ gradient produced by ___/__ ________ to antiport Ca2+.

VDCCs, sarcoplasmic reticulum, Ca2+ ATPase, decreasing VDCCs, sarcoplasmic reticulum, Ca2+ ATpases, Na+ Ca2+ antiporter, sodium, Na+ K+ ATPase

Phenylalkylamine AKA

VERAPAMIL

Pyridoxine AKA

VItamin B6

Very Low Density Lipoproteins AKA

VLDLs

Varicella Zoster Virus AKA

VZV

V-ATPase AKA

Vacuolar

HbS is the result of substitution of a single amino acid—___ for ___—at the ___ residue of the ____ chain.

Val, Glu, 6th, beta

Recurrent infection is common in HIV-infected patients, but the course is more severe. Intraoral lesions are often severe and can lead to bone involvement with loss of teeth. Which HIV periodontal condition?

Varicella Zoster Virus Infection

Valacyclovir 1 g PO tid; famciclovir 500 mg PO tid; acyclovir 800 mg PO 5 times per day. Intravenous acyclovir may be needed for severe virus in patients with immunosuppression. Which HIV periodontal condition?

Varicella Zoster virus infection

_________-______ virus infection in the skin. ______ _______ virus and _________ ________ virus both cause characteristic cytopathologic changes, including fusion of epithelial cells, which produces multinucleate cells with molding of nuclei to one another, and eosinophilic haloed nuclear inclusions

Varicella zoster, Herpes Simplex, Varicella Zoster

Midazolam AKA

Versed

Sickle cell: Light sedation can be provided with midazolam (_______) or nalbuphine hydrochloride

Versed

HIV transmission to children in the United States is mostly before or during birth. The use of a specific regimen of azidothymidine (zidovudine) reduces the chance of transmission by about two-thirds, and combinations of antiretroviral drugs further reduce the rate of mother-to-child transmission. The azidothymidine regimen has greatly reduced vertical transmission in resource-poor developing countries. However, the virus may also be transmitted via breastfeeding, and thus affordable alternatives to breastfeeding are needed. Which type of HIV transmission?

Vertical

Oral lesions caused by HPV (2)

Verucca Vulgaris Oral Squamous Papilloma

HIV: increases the ability of HIV to infect primary T cells and some nonpermissive cells in culture. Vif inhibits APOBEC-3G, a cellular RNA-editing enzyme that hypermutates the HIV genome.

Vif

•Persistent mucocutaneous herpes simplex virus infection •Cytomegalovirus retinitis or disseminated virus infection •Persistent or disseminated varicella zoster virus infection •Progressive multifocal leukoencephalopathy (reactivated JC virus) •Molluscum contagiosum poxvirus •Epstein-Barr virus hairy leukoplakia What type of opportunistic infectison in AIDS paitents?

Viral

filoviruses (e.g., Ebola, Marburg) and arenaviruses (e.g., Lassa, Machupo) What bioterrorism agent?

Viral Hemmorrhagic fevers

alphaviruses (e.g., Venezuelan equine encephalitis, Eastern equine encephalitis, Western equine encephalitis) What bioterrorism agent?

Viral encephalitis

Vif AKA

Virion Infectivity Factor

20-300 nm Obligate intracellular What type of pathogen?

Virus

Poliomyelitis is caused by what type of infectious agent?

Virus

Poliovirus infectious agent type

Virus

Thiamine AKA

Vitamin B1

Thiamine AKA Defeciency disaease?

Vitamin B1 Beriberi

Riboflavin AKA

Vitamin B2

Riboflavin AKA Defeciency disease?

Vitamin B2 Pellagra

Niacin AKA

Vitamin B3

Niacin AKA Defeciency disease?

Vitamin B3 Pellagra

Pyridoxone AKA Defeciency disease?

Vitamin B6 Neurological disease

participates in the regeneration of another antioxidant vitamin - α-tocopherol What vitamin?

Vitamin C

Defective ________ transport across the blood-brain barrier as a cause of seizures, and developmental delay

glucose

Ischemia-Reperfusion: New damage may be initiated during reoxygenation by increased generation of ___ from parenchymal and endothelial cells and from infiltrating leukocytes. When the supply of oxygen is increased, there may be a corresponding ____________ in the production of ROS, especially because _______________ damage leads to incomplete reduction of oxygen, and because of the action of oxidases in leukocytes, endothelial cells, or parenchymal cells. Cellular _______________ defense mechanisms may also be compromised by ischemia, favoring the accumulation of free radicals.

`ROS, increase, mitochondrial, antioxidant

The defining cells of adipose tissue (fat), ____________, are very large cells derived from mesenchyme and specialized for energy storage in lipid droplet(s) with ______________.

adipocytes, triglycerides

HIV transmission via blood: Sharing of needles contaminated with HIV-infected blood is a major route of transmission among injection drug users. Because all blood products in the United States are tested for HIV and other viruses, the risk of transmission via blood transfusions is very low. However, at the beginning of the AIDS epidemic, many individuals receiving clotting factors were exposed to HIV. Clotting factors are now genetically engineered. Health care workers are at risk for transmission from __________ __________ injuries or from exposure of broken skin and mucosal membranes to infected blood. However, the rate of seroconversion from such incidents is fortunately less than 1 % of those exposed to HIV-positive blood. This may be because the amount of infectious virus in the needle is very small, and larger volumes and repeated exposure are necessary for a significant probability of infection. Nevertheless, extreme care is necessary in handling needles and sharp instruments. Although the virus has been detected in tears, saliva, and urine, these sources have not been demonstrated to be infectious. Breast milk, however, is a source of infection of neonates.

accidental needlestick

H2-blockers (receptor antagonists) such as cimetidine and ranitidine indirectly inhibit ____ secretion by competing with __________ for its receptor

acid, histamine

At an ____ pH, R-proteins bind cobalamin more strongly than IF. In contrast to IF, they are normally degraded by __________ ___________. Thus, in __________ disease where R-proteins are not degraded, there is less cobalamin available to bind to IF, with loss of absorptive capacity for this vitamin.

acid, pancreatic proteins, pancreatic

A previously unknown disease emerged in the early 1980s, afflicting groups of individuals in certain risk groups in the United States who were dying of opportunistic infections. It is now known that this disease—_________ ___________________ __________—can develop in any individual exposed to the etiologic agent.

acquired immunodefeciency syndrome

A specific inherited defect in the absorption of zinc from the gut was identified in the 1970s; it was termed ________________ _____________ and presented with severe skin lesions, diarrhea and loss of hair (_________). Zinc deficiency also leads to impairment in taste and smell and to delayed ______ _______

acrodermatitis enteropathica, allopecia, wound healing

Sickle cell problems in guys aged birth - 20 years: painful events, stroke, ______ ____ __________ (fever, chest pain, wheezing, cough, and hypoxia), acute anemia and infection

acute chest syndrome

Fat necrosis refers to focal areas of fat destruction, typically resulting from release of activated pancreatic lipases into the substance of the pancreas and the peritoneal cavity. This occurs in the calamitous abdominal emergency known as _____ ______________ . In this disorder, pancreatic enzymes that have leaked out of acinar cells and ducts liquefy the membranes of fat cells in the peritoneum, and lipases split the triglyceride esters contained within fat cells. The released fatty acids combine with calcium to produce grossly visible chalky white areas (__ _____________), which enable the surgeon and the pathologist to identify the lesions. On histologic examination, the foci of necrosis contain shadowy outlines of necrotic fat cells with basophilic calcium deposits, surrounded by an inflammatory reaction.

acute pancreatitis, fat saponification

The phosphoanhydride bond of ATP releases free energy when it is hydrolyzed to produce ___________ ___________ and inorganic phosphate.

adenosine diphosphate

ATP, the energy store of cells, is produced mainly by oxidative phosphorylation of ___________ ___________ during reduction of oxygen in the electron transport system of mitochondria

adenosine diphsophate

There may be finite limits of the vasculature to adequately supply the enlarged fibers, of the mitochondria to supply _______ ______________, or of the biosynthetic machinery to provide the contractile proteins or other cytoskeletal elements.

adenosine triphosphate

Selected C albicans pathogenicity mechanisms: Yeasts adhere to host cells via ___________. This triggers the yeast-to-hyphal transformation and _____________ (directed growth). __________ induce the endocytotic uptake of the fungus by the host cell. The penetration into host cells and tissues is facilitated by adhesion, exertion of __________ forces, and secretion of fungal ___________. ________ are formed by the attachment of fungal cells to artificial surfaces (such as catheters) or host cell surfaces; yeasts are adjacent to the surface, and hyphal cells are found in the outer part of the biofilm. _____________ switching of the fungus may affect antigenicity and biofilm formation. A number of "_______ _______" affect the pathogenicity of the fungi, including a stress response (via heat shock proteins, ____), hyphae formation by amino acid uptake, extracellular _________________ via the export of ___________ (___), the uptake of compounds such as carbon and nitrogen sources, and the uptake of essential trace metals.

adhesins thigmotropism physical, hydrolases biofilms Phenotype fitness traits, Hsps, alklinzation, ammonia, NH3

Initial results indicate that mere activation of HIV in latently infected cells is not sufficient for the immune system to recognize and kill the cells and hence eliminate the reservoir. Additional strategies may include: • Administration of __________, ___________, and components of a therapeutic _______ to stimulate the immune system. • __ ____ (outside the body) activation of immune cells, such as cytotoxic T lymphocytes, __________ T cells, or _______ _________ cells, by cytokines or HIV peptides. • Genetic modification of patient peripheral blood cells to express _-cell receptors that can efficiently recognize viral antigens. • Use of ________-_____ conjugates that can recognize and kill virus-infected cells. • _____________-mediated delivery to infected cells of suicide gene constructs that are activated only in HlV-expressing cells.

antibodies, cytokines, vaccine Ex vivo, gammadelta, natural killer T antibody toxin Lentivirus

HIV infection can be diagnosed by the presence of __________ against _____ components, using _____ and whole viral lysates

antibodies, viral, ELISA

HIV: Uninfected cells ("innocent bystanders") may be killed by cytotoxic T cells that recognize HIV bound to the surface of the cell in a process known as ________-____________ ________ ____________. Cytotoxic T cells may also destroy uninfected cells that have taken up HIV particles and present viral fragments on their surface.

antibody mediated cellular cytotoxicity

Ways of increasing HIV expression: Use of _________-_____ conjugates that can recognize and kill virus-infected cells.

antibody toxin

Ca2+ channel blockers are ___________________ agents to inhibit the increase in cytoplasmic _____ concentration and thus the force of muscle contraction.

antihypertensive, Ca2+

Endogenous or exogenous ________________ (e.g., vitamins E, A, and C and β-carotene) may either block the formation of free radicals or scavenge them once they have formed.

antioxidants

The orientation of the DNA strands is ____________, i.e. the strands run in opposite directions

antiparallel

The human genome is composed of DNA, an ____________, ______-stranded ________ polymer of ___________________, stabilized by _________ binding between complementary _____.

antiparallel, double, helical, deoxyribonucleotides, hydrogen, bases

DNA is an _________________ dimer of _______ ____ strands

antiparallel, nucleic acid

ATP ADP translocase is an example of an _________ system; it allows one molecule of ADP to enter only if one molecule of ATP exits simultaneously.

antiport

The gastric protop pump ____________ two cytoplasmic __________ and two extracellular _____________ ions, coupled with hydrolysis of a molecule of ___; thus it is called an H+/K+-ATPase

antiports, protons, potassium, ATP

Inhibitors of vitamin K action are valuable _____________ drugs

antithrombotic

Immunosuppression with _____________ _________ alone or with cyclosporine is the most common therapy for aplastic anemia.

antithymocyte globulin

Hyphae elongate by growth at their tips (known as _______ __________) and may be hollow and multinucleated (___________) or divided (_________)

apical elongation, coenocytic, septate

Immunosuppression with antithymocyte globulin (ATG) alone or with cyclosporine is the most common therapy for _______ anemia.

aplastic

Moderate ___________ anemia is defined as more than 500 neutrophils/µL, more than 20,000 platelets/µL, and more than 20,000 reticulocytes/µL.

aplastic

Severe _________ anemia is defined as (two or more) neutrophils less than 500/µL, platelets less than 20,000/µL, and reticulocytes less than 20,000/µL

aplastic

The diagnosis of _________ anemia is based on the presence of anemia (normochromic, normocytic), thrombocytopenia (normal sized platelets), neutropenia, and no abnormal cells in the leukocyte differential.

aplastic

The most common initial signs and symptoms of _________ anemia are caused by anemia and thrombocytopenia: weakness, fatigue, headaches, dyspnea with exertion, petechiae, ecchymoses, epistaxis, metrorrhagia (bleeding between expected menstrual periods), and gingival bleeding.

aplastic

The oral findings associated with _________ anemia include petechiae, ecchymoses, mucosal pallor, ulceration (infection), gingival bleeding, and gingival hyperplasia

aplastic

Once the diagnosis of _________ anemia is established, family human leukocyte antigen (___) typing is recommended for patients 50 years of age or younger for possible stem cell transplantation from a histocompatible sibling.

aplastic, HLA

Severe thiamine deficiency results in ________, either '___' (without fluid retention) or '___' (associated with _______ failure with edema).

beriberi, dry, wet, cardiac

In poorly controlled diabetes mellitus, the prime example of abnormal glucose metabolism, glycogen accumulates in renal tubular epithelium, cardiac myocytes, and ____ cells of the islets of Langerhans.

beta

When the blood concentration of glucose increases, glucose is transported into the ____-cell through a glucose transporter (GLUT-2) and metabolized, resulting in an increase in cytoplasmic ATP concentration.

beta

In P brasiliensis, the ____-(_,_)-_______ induces an intense inflammatory response, and the gp43 protein elicits a strong humoral as well as a delayed-type hypersensitivity response.

beta 1 3 glucan

In candida albicans cell wall, which is more superficial- beta-1,6 glucan or beta-1,3 glucan?

beta 1,6 glucan

Conversion of carotenoids to vitamin A is rarely 100% efficient and the potency of foods is described in retinol activity equivalents (RAE); 1 µg of retinol is equivalent to 12 µg ____-________, or 24 µg of other carotenes.

beta carotene

Good sources of ____-________ are dark-green and yellow vegetables and tomatoes.

beta carotene

Supplementation of ____-________ to smokers was also harmful, resulting in an increase in lung cancer mortality.

beta carotene

The provitamin of vitamin A is a plant pigment ____-________ and other carotenoids

beta carotene

Beta carotene is converted in the small bowel to all-trans retinal by the action of the ____-________ ___________.

beta carotene dioxygenase

Some of the internal components of the cell wall, such as ____-_______, can be exposed on the cell surface in some locations (eg, the bud scar in Candida albicans).

beta glucans

The ____-_________ gramicidin A molecule, a linear peptide with 15 amino acid residues, forms a pore

beta helical

In response to the intake of food and the resulting increase in blood glucose concentration, GLUT-2 molecules respond by increasing the uptake of glucose into ____-cells, stimulating _______ secretion

beta, insulin

painful events, stroke, acute chest syndrome (fever, chest pain, wheezing, cough, and hypoxia), acute anemia and infection Sickle cell complications of what age group?

brith - 20 years

HIV: The ________ of a large number of virions from the cell surface may compromise the integrity of the plasma membrane. The large amounts of viral proteins and nucleic acids produced in the cell may affect the proper functioning of cellular processes.

budding

The G-proteins activate adenylyl cyclase, which generates ____. cAMP, in turn, activates _______ _______ _ . PTH, angiotensin II, norepinephrine and dopamine also trigger G-protein-mediated activation of _____________ _, which activates _______ ______ _. Both PKA and PKC affect Na+/K+-ATPase by ______ _______________ of its _____-subunit

cAMP, protein kinase A, phospholipase C, protein kinase C, serine phosphorlyation, alpha

Negative strand DNA AKA

cDNA

Necrotic cells may persist for some time or may be digested by enzymes and disappear. Dead cells may be replaced by myelin figures, which are either phagocytosed by other cells or further degraded into fatty acids. These fatty acids bind calcium salts, which may result in the dead cells ultimately becoming _________

calcified

Vitamin D (_______) is a hormone

calciol

DHP, dihydropyridine, nifedipine, a _______ _______ _________ used for treatment of _______________.

calcium channel blocker

Vitamin D excess causes enhanced _______ absorption and bone reabsorption, leading to ______________ and metastatic calcium deposition. The symptoms are anorexia, weight loss and polyuria, There is also a tendency to develop kidney stones because of the ________________ secondary to hypercalcemia.

calcium, hypercalcemia, hypercalciuria

It is now thought that certain environmental stresses, such as _______ ____________, alter signaling pathways that influence aging

calorie restriction

Benefits of vitamin supplementation in ______ and ______________ disease are uncertain

cancer, cardiovascular

When p53 is mutated or absent (as it is in certain _______), cells with damaged DNA that would otherwise undergo apoptosis survive

cancers

Erythematous palatal lesion in a human immunodeficiency virus antibody-positive patient. Smears taken from the lesion showed hyphae and spores consistent with ________. The lesion healed after a 2-week course of antifungal medications. A diagnosis of ___________ ____________ was made on the basis of clinical laboratory findings.

candida, erythmatous candidiasis

Cellular sweelling: When it affects many cells in an organ, it causes some pallor (as a result of compression of ______________), increased _________, and increase in __________ of the organ

capillaries, turgor, weight

HIV: The group-specific antigen gene, gag, encodes the ________ (p24), ________________ (p7), and _______ (p17) genes.

capsid, nucleocapsid, matrix

After bypassing host tissue barriers, infectious microorganisms must also evade host innate and adaptive immunity mechanisms to successfully proliferate and be transmitted to the next host. Strategies include: •Antigenic variation •Inactivating antibodies or complement •Resisting phagocytosis (e.g., by producing a _______) •Suppressing the host adaptive immune response (e.g., by inhibiting ___ expression and ________ presentation)

capsule MHC, antigen

Thiamine is important for _____________ metabolism. In its active form, _______ _____________ (___), it is a coenzyme of pyruvate dehydrogenase (the __ enzyme in the ___ complex

carbohydrate, thiamine pyrophosphate, TPP, E1, PDH

Mechanisms of apoptosis. The two pathways of apoptosis differ in their induction and regulation, and both culminate in the activation of ____________. In the mitochondrial pathway, proteins of the ___-_ family, which regulate _______________ permeability, become imbalanced and leakage of various substances from mitochondria leads to caspase activation. In the death receptor pathway, signals from _____ ________ ___________ lead to the assembly of adaptor proteins into a "________-___________ _____________ __________," which activates caspases, and the end result is the same.

caspases Bcl 2, micothondrial plasma membrane receptors, death inducing signaling complex

Apoptosis results from the activation of enzymes called __________ (so named because they are _________ proteases that cleave proteins after _________ residues)

caspases, cysteine, aspartate

________, present in peroxisomes, catalyzes the decomposition of hydrogen peroxide (2H2O2 → O2 + 2H2O). It is one of the most active enzymes known, capable of degrading millions of molecules of H2O2 per second.

catalase

The movement of one substrate uphill, against its concentration gradient, can be driven by antiport of another substrate (usually a ________ such as ___ or __) down a gradient.

cation, Na+, H+

The ____ _____ is the sequence of events that controls cell growth and division.

cell cycle

If the adaptive capability is exceeded or if the external stress is inherently harmful, ____ ______ develops

cell injury

The intracellular changes associated with reversible injury include (1) ______ ______________ alterations such as blebbing, blunting, or _____________ of microvilli, and ___________ of intercellular attachments; (2) _________________ changes such as swelling and the appearance of ____________-rich amorphous densities; (3) dilation of the __ with detachment of __________ and dissociation of __________; and (4) __________ alterations, with clumping of __________

cell membrane, distortion, loosening mitochondrial, phospholipid ER, ribosomes, polysomes nuclear, chromatin

Many therapeutic drugs can cause ____ or _________ injury in a susceptible patient or if used excessively or inappropriately

cell, tissue

The two main morphologic correlates of reversible cell injury are _________ _________ and _____ ________

cellular swelling, fatty change

The relationship among normal, adapted, reversibly injured, and dead myocardial cells. The _________ adaptation depicted here is hypertrophy, the type of ____________ injury is ischemia, and the _______________ injury is ischemic coagulative necrosis. In the example of myocardial ____________, the left ventricular wall is thicker than 2 cm (normal, 1-1.5 cm). Reversibly injured myocardium shows ______________ effects without any gross or light microscopic changes, or __________ changes like cellular swelling and fatty change . In the specimen showing _________ the transmural light area in the posterolateral left ventricle represents an acute myocardial infarction. All three transverse sections of myocardium have been stained with triphenyltetrazolium chloride, an enzyme substrate that colors viable myocardium __________. Failure to stain is due to _______ loss after cell death.

cellular, reversible, irreversible, hypertrophy, functional, reversible, necrosis, magenta, enzyme

Although water molecules can be transported by simple diffusion, ______ _______ are believed to control the movement of water across most membranes, especially in the kidney for concentration of the urine.

channel proteins

Membrane ________ or _______ are open, less selective conduits for transport of ions, metabolites and even proteins across biomembranes

channels, pores

The unfolded protein response and ER stress. A, In healthy cells, newly synthesized proteins are folded with the help of _____________ and are then incorporated into the cell or secreted. B, Various external stresses or mutations induce a state called __ _________, in which the cell is unable to cope with the load of misfolded proteins. Accumulation of these proteins in the ER triggers the _________ ________ ________, which tries to restore protein homeostasis; if this response is inadequate, the cell dies by ______________.

chaperones ER stress, ulfolded protein response, apoptosis

Over time, cells are unable to maintain normal protein homeostasis, because of increased turnover and decreased synthesis caused by reduced translation of proteins and defective activity of ___________ (which promote normal protein folding), ______________ (which destroy misfolded proteins) and repair enzymes. Abnormal protein homeostasis can have many effects on cell survival, replication, and functions. In addition, it may lead to accumulation of misfolded proteins, which can trigger pathways of apoptosis.

chaperones, proteasomes

Caseous necrosis. Tuberculosis of the lung, with a large area of caseous necrosis containing yellow-white (______) debris.

cheesy

For charged molecules and ions, transport across the membrane must be facilitated by a transporter or channel, and is driven by the electrochemical gradient, a combination of the concentration gradient (______________ potential) and the voltage gradient across the membrane (__________ potential).

chemical, electrical

Vasopressin regulates water reabsorption in the _________ ____. Vasopressin controls the _________ _ water channel. Vasopressin binds to its receptor (__) and, through G-proteins, (__) stimulates production of ____, which, in turn, activates ______ ______ _. PKA ____________ cytoplasmic AQP2 and induces its translocation to the ____ ________, _________ capacity for water transport. Vasopressin also regulates expression of the ____ gene.

collecting duct, aquaporin 2, VR, Gp, cAMP, protein kinase A, phosphorlyates, cell membrane, increasing, AQP2

Morphologic appearance of apoptotic cells. Apoptotic cells in a normal crypt in the colonic epithelium are shown. (The preparative regimen for ______________ frequently induces apoptosis in epithelial cells, which explains the abundance of dead cells in this normal tissue.) Note the _____________ nuclei with ___________ chromatin and the ____________ cell bodies, some with pieces falling off.

colonosocpy, fragmented, condensed, shrunken

Zinc deficiency is ______

common

C albicans binding to ___________ can inhibit phagocytosis.

complement

Additional levels of chromatin fiber condensation are less well understood and involve nonhistone proteins, including complexes of __________

condensins

Vegetative hyphae grow on or below the surface of a "solid" growth medium like agar, whereas aerial hyphae extend above the surface of the medium and can produce asexual reproductive structures called _______ (in Aspergillus species) or _________________ (in Rhizopus species)

conidia, sporangiophores

Hyperplasia also is an important response of ____________ tissue cells in wound healing, in which proliferating ____________ and _____ _________ aid in repair

connective, fibroblasts, blood vessels

Transmission of infections can occur by _______ (direct and indirect), _____________ droplets, _____-_____ route, _________ transmission, _________ transmission from mother to fetus or newborn, or ______/____________ vectors.

contact, respiratory, fecal oral, sexual, vertical, insect, arthropod

Hyperplasia: An important point is that in all of these situations, the hyperplastic process remains ____________; if the signals that initiate it abate, the hyperplasia ___________.

controlled, disappears

Zinc from shares transport mechanisms with ______ and ____the gut

copper, iron

Separated DNA strands can reassociate to form ______ ___

duplex DNA

Types of pathologic calcifications (2)

dystrophic metatsatic

When the deposition occurs in dead or dying tissues, it is called _______________ calcification; it occurs in the absence of derangements in calcium metabolism (i.e., with ___________ serum levels of calcium).

dystrophic, normal

HIV drug: RT is also inhibited by other mechanisms by non-nucleoside inhibitors (____________).

efaviranez

Patients who are on ART medications must be closely monitored for drug ______________ (which often wanes over time), development of antiviral __________, drug __________, and drug ____________.

effectiveness, resistance, toxicity, interactions

Risk factors for folate deficiency include poor diet (seen frequently in the poor, __________ persons, and people who do not eat fresh ______ or _______________), alcoholism, history of malabsorption disorders, and pregnancy (especially the ___ trimester).

elderly, fruits, vegetables, 3rd

Na+/K+-ATPases also create an _______________ ________ of Na+ that produces the driving force for uptake of nutrients from the intestine

electrochemical gradient

Passive movement of electrolytes through ion channels is driven by the _______________ ________

electrochemical gradient

Secondary active transport uses __________________ gradients of ___ and __, or membrane potential produced by ________ ______ transport processes. _______, _______, and _________ are examples of secondary active transport.

electrochemical, Na+, H+, secondary active, uniport, symport, antiport

Body water balance is closely linked to the balance of dissolved ions (___________), the most important of which are ______ and __________.

electrolytes, sodium, potassium

There has been great interest in defining signaling pathways that counteract the aging process, not only because of their obvious therapeutic potential (the search for the "______ __ ______") but also because elucidating these pathways might tell us about the mechanisms that cause aging.

elixir of youth

Apoptosis: The programmed destruction of cells during ________________. Normal development is associated with the death of some cells and the appearance of new cells and tissues. The term __________ _____ _____ was originally coined to denote this death of specific cell types at defined times during the development of an organism. Apoptosis is a generic term for this pattern of cell death, regardless of the context, but it is often used interchangeably with programmed cell death.

embryogenesis, programmed cell death

Abnormal intracellular accumulation: Accumulation of an abnormal ___________ substance as a result of ________ or ___________ defects in its folding, packaging, transport, or secretion, as with certain mutated forms of α1-antitrypsin

endogenous, genetic, acquired

patients with hyperplasia of the endometrium are at increased risk of developing ___________ ______

endometrial cancer

HIV-1 infection is divided into stages: _______, reverse transcription of ___ to ___, export of the viral ___ from the ___________ to the __________ and integration into the host chromosome, _____________, ______________ and ________ of the polyproteins produced, assembly of virions, and budding of virions

entry, RNA, DNA, DNA, cytoplasm, nucleus, transcription, translation, cleavage

HIV: The envelope, ___, gene codes for the transmembrane gp41 protein and the surface protein gp120, which form trimers and are trafficked to the plasma membrane.

env

Necrosis: Necrotic cells show increased ______________ (i.e., ____ staining from the _____ dye—the _ in the hematoxylin and eosin [___] stain), attributable in part to increased binding of ______ to denatured cytoplasmic proteins and in part to loss of the _____________ that is normally imparted by the ribonucleic acid (___) in the cytoplasm (basophilia is the ____ staining from the hematoxylin dye—the _ in "H&E").

eosinophilia, pink, eosin, E, H&E, eosin, basophilia, RNA, blue, H

Fatty change: Injured cells may also show increased ______________ staining, which becomes much more pronounced with progression to __________

eosinophillic, necrosis

While the Z-DNA form is favored at high ionic concentrations, it can also be induced at normal ionic concentrations by methylation of cytosine residues, a form of __________ ____________ of DNA

epigenetic modification

Granulomatous inflammation (Chapter 2) is characterized by accumulation of activated macrophages called "____________" cells, which may fuse to form _____ cells. In some cases, there is a central area of _______ necrosis

epihtheliooid, giant, caseous

Glucose is reabsorbed primarily by sodium glucose transporter 2 (SGLT2; one-to-one Na+: Glc stoichiometry) into renal proximal tubular ____________ cells.

epithelial

Some viruses can cause _____________ cells to proliferate (e.g., venereal warts caused by HPV or the umbilicated papules of molluscum contagiosum caused by poxviruses).

epithelial

Metaplasia is a reversible change in which one adult cell type (____________ or ___________) is replaced by another adult cell type

epithelial, mesenchymal

Routes of entry and dissemination of microbes. To enter the body, microbes penetrate ____________ or ___________ barriers. Infection may remain ____________ at the site of entry or spread to other sites in the body. Most common microbes (selected examples are shown) spread through the ___________ or ______________ (either freely or within inflammatory cells). However, certain viruses and bacterial toxins also may travel through _______.

epithelial, mucosal, localized, bloodstream, lymphatics, nerves

The fungal cell membrane differs from that of other eukaryotic cells in that it contains ____________ and is surrounded by the ____ ____

ergosterol, cell wall

The fungal cell structure is similar to that of other eukaryotic cells, except that the cell membrane contains ___________ instead of cholesterol and the cell is surrounded by a rigid ____ ____ whose composition differs from that of bacterial and plant cell walls

ergosterol, cell wall

Sickle cell anemia: Therapeutic strategies include the use of hydroxyurea (with or without ________________), which induces production of HbF and thus prevents formation of HbS polymers

erythropietin

Humans cannot synthesize ascorbic acid; therefore it is an _________ nutrient

essential

Arterial hypertension has been classified as '_________' (primary) or '__________'.

essential, secondary

Mammalian ________ binds specifically to proteins of P brasiliensis and blocks specifically the transition from the saprophytic form to the invasive form of the microorganism in vitro

estrogen

Mammalian estrogen binds specifically to proteins of P brasiliensis and blocks specifically the transition from the saprophytic form to the invasive form of the microorganism in vitro. This block also occurs in vivo. These observations point to the involvement of ________-_______ _________ binding in the pathogenesis of P brasiliensis.

estrogen fungus receptor

Chromatin with DNA that is active in transcription stains lightly and is called ___________; inactive chromatin stains more darkly and is called _____________

euchromatin, heterochromatin

The mitochondrial and death receptor pathways lead to the activation of the initiator caspases, caspase-9 and -8, respectively. Active forms of these enzymes are produced, and these cleave and thereby activate another series of caspases that are called the ____________ __________

executioner caspases

PEP of HIV: The _________ regimen includes a standard _-drug regimen plus a protease inhibitor such as ritonavir-boosted (/r) lopinavir, darunavir/r, atazanavir/r, or raltegravir

expanded, 2

Patients with anemia also may describe a sore or painful tongue (___________), a smooth tongue, or redness of the tongue or cheilosis

glossitis

Fragments of the apoptotic cells then break off, giving the appearance that is responsible for the name (apoptosis, "_________ ___").

falling off

Iron metabolism: Dietary iron is absorbed in the intestine and either stored in enterocytes as ________ or transported out to plasma. Hephaestin and ferroportin are iron transporters located in the ____________ _______ of the __________. In plasma, iron remains bound to ___________. It is taken up by cells such as _____________, through the mediation of the membrane transferrin receptor. In erythroblasts, iron is incorporated into ____, and then __________. Old erythrocytes are degraded by ____________ in the ___________________ system. Liberated iron is released from cells and recycled bound to __________. Note that the dietary iron is in the ______ (____) form. This is reduced to ______ ion (____) at the intestinal brush border. The transported form of iron is ______ again, but the form incorporated into heme is _______.

ferretin basolateral membrane, enterocytes transferrin, erythroblasts heme, hemoglobin, macrophages, reticuloendothelial transferrin, ferric, Fe3+, ferrous, Fe2+ ferric, ferrous

In children, iron supplements (_______ _______, _ to _ mg/kg/day) are recommended to arrest motor and cognitive impairment brought on by iron deficiency

ferrous sulfate, 2, 6

___________ necrosis in an artery in a patient with polyarteritis nodosa. The wall of the artery shows a circumferential bright pink area of necrosis with protein deposition and inflammation.

fibrinoid

Fibrinoid necrosis: a special form of necrosis, visible by light microscopy, usually in immune reactions in which complexes of antigens and antibodies are deposited in the walls of arteries. The deposited immune complexes, together with fibrin that has leaked out of vessels, produce a bright pink and amorphous appearance on H&E preparations called ___________ (_________-like) by pathologists. The immunologically mediated diseases (e.g., ______________ __________)

fibrinoid, fibrin, polyarteritis nodosa`

By TEM, an active nucleolus is seen to have _______ and _______ parts where rRNA forms and ribosomal subunits are assembled, respectively.

fibrous, glanular

Synaptic pairs separate toward two daughter cells at the _____ meiotic division.

first

A deficiency in daily ______ intake (as in chronic alcoholism) or absorption (due to celiac disease or tropical sprue) of these vitamins can result in anemia.

folate

Adequate intake of ______ around conception is essential

folate

Because supplementation of _____ ____ and vitamin __ and ___ lowers plasma homocysteine concentration, it has been suggested that it could be beneficial for the prevention of cardiovascular disease. There also were suggestions that supplementation of vitamins _, _ and _ is protective against cancer. Some observational studies suggested that the supplementation of vitamins _ and _ could also be useful in the prevention of cardiovascular disease.

folic acid, B6, B12 A, C, E C, E

HIV still replicates in lymph nodes and is trapped by __________ _________ cells that are located in germinal centers.

follicular dendritic

Salmonella spp., Escherichia coli O157:H7, Shigella, others What bioterrorism agent?

food safety threats

Cellular aging: Results from combination of accumulating cellular damage (e.g., by ____ ___________), reduced capacity to divide (___________ ___________), and reduced ability to repair damaged DNA

free raadicals, replicative sensencnce

Cell injury in many circumstances involves damage by _____ _________; these situations include ischemia-reperfusion, chemical and radiation injury, toxicity from oxygen and other gases, cellular aging, microbial killing by phagocytic cells, and tissue injury caused by inflammatory cells.

free radicals

Cellular _________ may be lost long before cell _____ occurs, and the morphologic changes of cell injury (or _____) lag far behind both

function, death, death

Cell injury results from ____________ and ______________ abnormalities in one or more of several essential cellular components. The principal targets and biochemical mechanisms of cell injury are: (1) mitochondria and their ability to generate ATP and ROS under pathologic conditions; (2) disturbance in calcium homeostasis; (3) damage to cellular (plasma and lysosomal) membranes; and (4) damage to DNA and misfolding of proteins.

functional, biochemical

Additional coreceptors that allow HIV to infect human cells include CCR5, CXCR4 (_____), and CCR2

fusin

HIV: Membrane __________ and viral entry is dependent on the secondary receptor, which is a G-protein-coupled ____________ receptor.

fusion, chemokine

HIV: The group-specific antigen gene, ___, encodes the capsid (p24), nucleocapsid (p7), and matrix (p17) genes.

gag

The HIV genome has three main gene clusters: ___, ___, ___

gag, pol, env

Meiosis is the process by which two successive cell divisions produce cells called _______ containing half the number of chromosomes found in somatic cells.

gametes

The ___ ___________ between endothelial, muscle, and neuronal cells is a cluster of small pores, in which two cylinders of six _________ subunits in the plasma membranes join each other to form a pore about 1.2-2.0 nm (12-20 Å) in diameter

gap junction, connexin

mild iron defeciency anemia in men usually indicates the presence of a serious underlying medical problem (e.g., _________________ bleeding, malignancy).

gastrointestinal

Alternative forms of DNA may help to regulate ____ expression

gene

After HIV acute phase, the infection may become asymptomatic or turn into ongoing _________ ________________.

generalized lymphadenopathy

Hypertrophy and hyperplasia also can occur together, and obviously both result in an enlarged (___________) organ.

hypertrophic

Protracted use of barbiturates leads to a state of tolerance, with a decrease in the effects of the drug and the need to use increasing doses. This adaptation is due to increased volume (______________) of the smooth ER of hepatocytes and consequent increased P-450 enzymatic activity.

hypertrophy

Serum potassium concentration is maintained within narrow limits. Both low (___________) and high (____________) concentrations are be dangerous, as potassium affects the ____________ of heart muscle. Generally, serum potassium concentrations above ___ mmol/L and below ___ mmol/L are regarded as emergencies. The upper panel shows main sources of potassium loss.

hypokalemia, hyperkalemia, contractility, 2.5, 6.0

A decreased sodium concentration (____________) usually indicates that the extracellular fluid is being '_________' (due to an ______ of water), whereas an increased sodium concentration (_____________) means that the extracellular fluid is being '_____________' (due to water ____).

hyponatremia, diluted, excess, hypernatremia, concentrated, loss

Based on the absolute reticulocyte count in the presence of anemia, a value below 75,000/µL indicates ____________________ anemias, and a value greater 100,000/µL indicates _____________ or an appropriate _________________ response

hypoporlifaerative, hemolysis, erythropoietic

A majority of cases of aplastic anemia, however, are ____________ (50% to 65%)

idiopathic

Some microbes have devised methods for actively resisting ______ defenses.

immune

Ways of increasing HIV expression: • Administration of cytokines, antibodies, and components of a therapeutic vaccine to stimulate the ________ system.

immune

In about 25% of patients, particularly those with a very low CD4+ T cell count, weeks after initiation of ART, an exacerbation of preexisting opportunistic infections occurs. This condition, known as ______ _______________ __________ __________, probably results from elicitation of an inflammatory response in association with the antiviral drugs, leading to focal lymphadenitis and reactivation of a viral disease (e.g., _______) or granulomatous infection

immune reconstitution inflammatory syndrome, shingles

In normal (__________________) persons, the patterns of host responses are fairly stereotypical for different classes of microbes; these response patterns can be used to infer possible causal organisms.

immunocompetent

Although many viral cytopathic effects (e.g., cell fusion or inclusions) may still be present, viral infections in _________________ hosts may not engender the anticipated mononuclear inflammatory response.

immunocompromised

Aplastic anemia: The patients who do not respond to immunosuppression can benefit from a second course of __________________ (about __% of these patients respond to the second treatment)

immunosuppression, 75

Some viruses replicate within cells and make viral aggregates that are visible as ________ _______ (e.g., herpesviruses or adenovirus) or induce cells to fuse and form multinucleated cells called ______________ (e.g., measles virus or herpesviruses)

inclusion bodies polkyaryons

Some hormones appear to alter the Na+/K+-ATPase activity by changing its apparent affinity for sodium (for instance, angiotensin II and insulin ________ the affinity).

increase

HIV: The genome is flanked by RNA sequences called ____ _________ _______ that comprise promoter and enhancer gene sequences that bind transcription factors.

long terminal repeat

An ________ in ECF osmolality stimulates secretion of vasopressin and leads to increased renal water reabsorption. This 'dilutes' the ECF and the osmolality _________. This response is reinforced by the stimulation of ______. A ________ in the plasma volume also stimulates water retention through stimulation of the pressure-sensitive receptors (_____________) in the juxtaglomerular apparatus. *Osmolality will _________ if the degree of water retention is relatively greater than that of sodium retention.

increase, decreases, thirst decrease, baroreceptors decrease

Hypertrophy is an ________ in the size of cells resulting in _________ in the size of the organ

increase, increase

Renin secretion is also _________ by norepinephrine and prostaglandin E2 (PGE2).

increased

Angiotensin receptor I stimulation: _________ ROS production _________ matrix deposition in the intima

increased increased

HIV: More than 40% of new infections (excluding those in ________) occur in young people __ to __ years of age

infants, 15, 24

Myocardium may be reversibly injured if the stress is mild or the arterial occlusion is incomplete or sufficiently brief, or it may undergo irreversible injury and cell death (__________) after complete or prolonged occlusion.

infarction

Apoptosis due to cell injjry in certain ______________, particularly viral infections, in which loss of infected cells is largely due to apoptotic death that may be induced by the virus (as in ____________ and _____ ________________ ______ nfections) or by the host __________ response (as in viral hepatitis).

infections, adenovirus, human immunodefeciency virus, immune

Cells that are dying by apoptosis secrete soluble factors that recruit phagocytes. This facilitates prompt clearance of the dead cells before they undergo secondary membrane damage and release their cellular contents (which can induce _____________)

inflammation

Necrosis: Cellular contents also leak through the damaged plasma membrane into the extracellular space, where they elicit a host reaction (_____________)

inflammation

Necrosis: The leaked cellular contents often elicit a local host reaction, called ____________, that attempts to eliminate the dead cells and start the subsequent repair process

inflammation

The ______________ that is induced by ischemic injury may increase with reperfusion because of increased influx of leukocytes and plasma proteins. The products of activated leukocytes may cause additional tissue injury. Activation of the ______________ system may also contribute to ischemia-reperfusion injury. Complement proteins may bind in the injured tissues, or to antibodies that are deposited in the tissues, and subsequent complement activation generates by-products that exacerbate the cell injury and inflammation.

inflammation, complement

Apoptosis: The dead cell and its fragments are rapidly cleared before cellular contents have leaked out, so apoptotic cell death does not elicit an ______________ reaction in the host.

inflammatory

In keeping with its role in certain physiologic processes, apoptosis does not elicit an _______________ response.

inflammatory

Generally, AT1 receptor activation has effects that _______ cardiovascular disease: the stimulation of ____________ phenomena, _____________ ______deposition, and generation of ________ ______ _______

inflammatory, extracellular matrix, reactive oxygen species

In P brasiliensis, the β-(1,3)-glucan induces an intense ________________ response, and the gp43 protein elicits a strong _________ as well as a _________-type hypersensitivity response.

inflammatory, humoral, delayed

Coagulative necrosis. A, A wedge-shaped kidney ________ with preservation of the outlines. B, Microscopic view of the edge of the infarct, with normal kidney and ________ cells in the infarct (I). The necrotic cells show preserved outlines with loss of ______, and an ______________ infiltrate is present

infract necrotic, nuclei, inflammatory

The pathogenesis of dystrophic calcification involves ____________ (or nucleation) and ______________, both of which may be either intracellular or extracellular; the ultimate end product is the formation of crystalline ________ ___________

initiation, propotgation, calcium phosphate

An overview of mechanisms used by viral and bacterial pathogens to evade ______ and _________ immunity.

innate, adaptive

sweat contains ____ sodium than extracellular fluid: therefore, excessive sweating leads to a predominant loss of _____ and 'concentrates' sodium in the extracellular fluid, causing _____________. On the other hand, sodium content of the intestinal fluid is similar to that of plasma but contains considerable amounts of _________. Thus, its loss (for instance, in severe diarrhea) would result in ___________ and ___________, but may not change plasma ______ concentration

less, water, hypernatremia potassium, dehydration, hypokalemia, sodium

To insure that excess amounts of unfinished, replicating DNA do not accumulate, cells use a protein termed a _________ ______ that is present in the nucleus prior to replication.

licensing factor

DNA ______ joins the lagging-strand DNA fragments to form a continuous strand.

ligase

Candidiasis, hairy leukoplakia, specific forms of periodontal disease (i.e., ______ ________ ________ and ___________ __________ _____________), Kaposi sarcoma, and non-Hodgkin's lymphoma are reported to be strongly associated with HIV infection

linear gingival erythema, Necrotizing Ulcerative Periodontitis

General sensation to the anterior two-thirds of the tongue is supplied by the _________ nerve, a nerve of the ___ pharyngeal (branchial) arch

lingual

Fatty acids are released from white adipocytes by _______ activity when nutrients are needed and carried throughout the body on plasma proteins such as albumin.

lipase

phagocytic cells may become overloaded with _____ (triglycerides, cholesterol, and cholesteryl esters) in several different pathologic processes.

lipid

Oxygen free radicals cause injury to cell membranes by ______ _____________

lipid peroxidation

Reactive oxygen species cause cell injury by three main reactions (Fig. 1-19): •______ _______________ of membranes. Double bonds in membrane polyunsaturated lipids are vulnerable to attack by oxygen-derived free radicals. The lipid-radical interactions yield peroxides, which are themselves unstable and reactive, and an autocatalytic chain reaction ensues. •______-_________and other changes in proteins. Free radicals promote sulfhydryl-mediated protein cross-linking, resulting in enhanced degradation or loss of enzymatic activity. Free radical reactions may also directly cause polypeptide fragmentation. •___ damage. Free radical reactions with thymine in nuclear and mitochondrial DNA produce single-strand breaks. Such DNA damage has been implicated in cell death, aging, and malignant transformation of cells.

lipid peroxidation cross linking DNA

liquefactive necrosis is seen in focal bacterial or, occasionally, fungal infections, because microbes stimulate the accumulation of inflammatory cells and the enzymes of leukocytes digest ("_____________") the tissue. For obscure reasons, hypoxic death of cells within the central nervous system often evokes liquefactive necrosis. Whatever the pathogenesis, the dead cells are completely digested, transforming the tissue into a liquid viscous mass. Eventually, the digested tissue is removed by phagocytes. If the process was initiated by acute inflammation, as in a bacterial infection, the material is frequently creamy yellow and is called ___

liquefy, pus

Vitamin A is stored in the _____ and needs to be transported to its sites of action

liver

Tissues with a greater glycolytic capacity (e.g., the _____) are able to survive loss of oxygen and decreased oxidative phosphorylation better than are tissues with limited capacity for glycolysis (e.g., the _____).

liver, brain

All coagulation factor proteins are synthesized by the _____ as inactive precursors and are activated by the _____________ of specific ________ ____ (___) residues by a vitamin _-dependent enzyme

liver, carboxylation, glutamic acid, Gla, K

Severe vitamin A deficiency occurs mostly in the developing world but it is also fairly common in patients with severe _____ disease or ___ malabsorption (e.g. cystic fibrosis).

liver, fat

Mononuclear and granulomatous inflammation. A, Acute viral hepatitis characterized by a predominantly ___________ infiltrate. B, Secondary syphilis in the dermis with perivascular ____________________ infiltrate and ____________ proliferation. C, Granulomatous inflammation in response to tuberculosis. Note the zone of ____________ , which normally forms the center of the _____________, with a surrounding rim of activated epithelioid ____________, some of which have fused to form _____ cells (arrows); this in turn is surrounded by a zone of activated _ cells. This high-magnification view highlights the histologic features; the _______________ response typically takes the form of a three-dimensional sphere with the offending organism in the central area.

lymphocytic lymphoplasmocytic, endothelial caesatation, granuloma, macrophages giant, T, granulomatous

Injury to _________ _________ results in leakage of their enzymes into the cytoplasm and activation of the acid hydrolases in the acidic intracellular pH of the injured (e.g., __________) cell. Lysosomes contain ribonucleases (__________), DNases, proteases, glucosidases, and other enzymes. Activation of these enzymes leads to enzymatic digestion of cell components, and the cells die by necrosis.

lysosomal membrane, ischemic, RNAses

H capsulatum mutants without the α-(1,3)-glucan are still able to survive within ______________.

macrophages

HIV: All of the viral components are assembled at the plasma membrane, and the virus buds, taking with it some cellular membrane proteins, including the _____ __________________ ________

major histocompatibility complex

Plasmoidum falciparium causes what?

malaria

the influences that induce metaplastic change, if persistent, may predispose to _____________ transformation of the epithelium.

malignant

Schematic structure of the Candida albicans cell wall, showing the carbohydrate-rich layers comprising ______ (mannosylated proteins), β-glucan, and chitin

mannan

The components of the fungi cell wall include galactomannan, ______ (α-1,6-linked polymer of D-mannose, with α-1,2 and α-1,3-linked branches of 1 to 5 residues), _____-________ (α-1,3- and α-1,4-linked polymer of D-glucose), ________-________ (β-1,3-linked polymer of D-glucose, with β-Ι,6-linkages at branch points), ___________ (β-1,4-linked polymer of D-glucose), _______ (β-1,4-linked polymer of D-glucosamine), and _______ (β-1,4-linked unbranched polymer of N-acetylglucosamine).

mannan, alpha glucan, beta glucan, cellulose, chitosan, chitin

Schematic structure of the Candida albicans cell wall, showing the carbohydrate-rich layers comprising mannan (____________ proteins), β-glucan, and chitin

mannosylated

HIV drug: Binding of gp120 to the CCR5 co-receptor is inhibited with a receptor agonist (_________)

maraviroc

The mechanisms driving cardiac hypertrophy involve at least two types of signals: __________ triggers, such as stretch, and _______ triggers, which typically are soluble mediators that stimulate cell growth, such as growth factors and adrenergic hormones.

mechanical, trophic

The thyroid gland develops between the ______ _____ ____ (tuberculum impar) and the ________ (on day 24 of intra-uterine life).

median tongue bud, copula

by explaining the causes and development of disease pathology provides the scientific foundation for the practice of _________

medicine

Hemolytic anemia: dental radiographs may show enlarged bone marrow (____________) spaces associated with bone marrow _______________, increased widening and decreased numbers of _______________, and generalized _______________ (thinning of the _________ border of the _________).

medullary, hyperplasia, trabeculations, osteoporosis, inferior, mandible

Mechanisms of intracellular accumulation: (1) Abnormal ______________, as in fatty change in the liver. (2) Mutations causing alterations in protein _________ and _____________, so that defective molecules accumulate intracellularly. (3) A deficiency of critical __________ responsible for breaking down certain compounds, causing substrates to accumulate in ___________, as in lysosomal storage diseases. (4) An inability to degrade ______________ particles, as in carbon pigment accumulation.

metabolism folding, transport enzymes, lysosomes phagocytosized

Toxic injury: Many chemicals are not intrinsically biologically active but must be first converted to reactive toxic ______________, which then act on target cells. This modification is usually accomplished by the cytochrome P-450 in the smooth ER of the liver and other organs. Although the metabolites might cause membrane damage and cell injury by direct covalent binding to protein and lipids, the most important mechanism of cell injury involves the formation of free radicals. ________ _______________—once widely used in the dry cleaning industry but now banned—and the analgesic _______________ belong in this category. The effect of ____ is still instructive as an example of chemical injury. ____ is converted to the toxic free radical _____ , principally in the liver, and this free radical is the cause of cell injury, mainly by membrane phospholipid peroxidation. In less than 30 minutes after exposure to _____, there is breakdown of ER membranes with a decline in hepatic protein synthesis of enzymes and plasma proteins; within 2 hours, swelling of the smooth ER and dissociation of ribosomes from the smooth ER have occurred. There is reduced lipid export from the hepatocytes, as a result of their inability to synthesize apoprotein to form complexes with triglycerides and thereby facilitate lipoprotein secretion; the result is the "fatty liver" of ____ poisoning. Mitochondrial injury follows, and subsequently diminished ATP stores result in defective ion transport and progressive cell swelling; the plasma membranes are further damaged by fatty aldehydes produced by lipid peroxidation in the ER. The end result can be calcium influx and eventually cell death.

metabolites, Carbon tetrachloride, acetometophin, CCl4, CCl4, CCl4

the deposition of calcium salts in normal tissues is known as ________________ calcification and is almost always secondary to some derangement in calcium metabolism (________________)

metastatic, hypercalcemia

deposition of calcium in normal tissues, caused by hypercalcemia (usually a consequence of parathyroid hormone excess)

metatstatic calcification

Folate absorption and metabolism are interfered with by alcohol consumption and certain drugs (______________, ________)

methotrexate, phenytoin

Folic acid (pteroyl-L-glutamic acid) exists in a number of derivatives collectively known as folates. It participates in single carbon transfer reactions such as ____________ (important in both metabolism and regulation of gene expression), and in __________ pathways of choline, serine, glycine and methionine.

methylation, synthetic

Deficiency of vitamin B12 results in the accumulation of _______________ ____ and ____________, and consequent _____________ _________ and ______________.

methylmalonic acid, homocysteine, methylmalonicaciduria, homocystinuria

In ____________ anemia (iron deficiency), the physician should look for a source of bleeding.

microcytic

In accordance with the size of RBCs, anemia is classified as ___________ (MCV less than 80 fL [or µm3]), _____________ (MCV greater than 100 fL), or ______________ (MCV of 80 to 100 fL).

microcytic, macrocytic, normocytic

Vitamins and trace elements are ______________ essential for __________

micronutrients, metabolism

Genes for specific proteins are unique DNA sequences that are present in single copies or at most only a few copies per genome. There are also several types of repeated DNA sequences within the genome. These are divided into two major classes: _______ repetitive (<10 copies per genome) and ______ repetitive (>10 copies per genome).

middle, highly

Apoptosis due to Accumulation of _________ __________: Improperly folded proteins may arise because of mutations in the genes encoding these proteins or because of extrinsic factors, such as damage caused by free radicals. Excessive accumulation of these proteins in the ER leads to a condition called ER stress, which culminates in apoptotic death of cells.

misfolded proteins

Cell injury results from functional and biochemical abnormalities in one or more of several essential cellular components. The principal targets and biochemical mechanisms of cell injury are: (1) _______________ and their ability to generate ATP and ROS under pathologic conditions; (2) disturbance in _______ homeostasis; (3) damage to cellular (________ and ____________) membranes; and (4) damage to ___ and misfolding of ____________.

mitochondira calcium lysosomal, plasma DNA, proteins

As discussed earlier, damage to _____________ __________ results in decreased production of ATP, with many deleterious effects culminating in necrosis.

mitochondrial membranes

In growht factor deprivation, apoptosis is triggered by the _______________ pathway and is attributable to activation of pro-apoptotic members of the ___-_ family and decreased synthesis of ___-_ and ____-__

mitochondrial, Bcl-2, Bcl-XL

Two distinct pathways converge on caspase activation: the ___________ pathway and the _____ __________ pathway

mitochondrial, death receptor

_______________ (____________) apoptosis pathway is triggered by loss of survival signals, DNA damage and accumulation of misfolded proteins (__ ________); associated with leakage of pro-apoptotic proteins from mitochondrial membrane into the cytoplasm, where they trigger caspase activation; inhibited by anti-apoptotic members of the Bcl family, which are induced by survival signals including growth factors.

mitochondrial, intrinsic, Er stress

Although there are no definitive morphologic or biochemical correlates of irreversibility, two phenomena consistently characterize irreversibility: the inability to correct _____________ dysfunction (lack of oxidative phosphorylation and ATP generation) even after resolution of the original injury, and profound disturbances in __________ function.

mitochondrial, membrane

Those few proteins that are encoded by the mitochondrial genome are synthesized in the ______________, using machinery similar that used in the _________ for synthesis of nonmitochondrial proteins

mitocondrion, cytoplasmic

Some fungi can switch between the ____ and ____ phases and are known as dimorphic fungi

mold, yeast

Some pathogenic fungi grow as _____ in the environment and convert to the _____ phase when they infect tissues.

molds, yeast

Chemical injury: Some chemicals act directly by combining with a critical ___________ component or ____________ organelle. For example, in __________ ___________ poisoning (as may occur from ingestion of contaminated seafood),mercury binds to the sulfhydryl groups of various cell membrane proteins, causing inhibition of ATP-dependent transport and increased membrane permeability. Many antineoplastic chemotherapeutic agents also induce cell damage by direct cytotoxic effects. In such instances, the greatest damage is sustained by the cells that use, absorb, excrete, or concentrate the compounds.

molecular, cellular, mercuric chloride

Main circulating form of folate

monoglutamate-N5-methylTHF

Transport processes may be classified into three general types: uniport (__________), symport (______________) and antiport (________________)

monoport, cotransport, countertransport

Medical management of the HIV-infected patient has four main treatment goals: (1) to reduce HIV-associated ___________ and ________ the duration and quality of survival, (2) to restore and preserve ___________ function, (3) to maximally and durably suppress plasma HIV _____ ____, and (4) to prevent HIV ______________.

morbidity, maximize immunological viral load transmission

The mechanisms of atrophy consist of a combination of decreased _______ __________ and increased ________ ____________ in cells.

protein synthesis, protein degradation

All transporters are indispensable for homeostasis. The expression of unique sets of transporters is important for specific cell functions such as ___________ contraction, nutrient and ion ____________ by intestinal epithelial cells, resorption of nutrients by _________ cells, and secretion of acid from gastric ___________ cells.

muscle, absorption, kidney, parietal

After chromosomal replication, the resulting daughter strand contains a different DNA sequence (________) from the parent strand

mutation

The conglomeration of hyphae results in the formation of a _________

mycelium

an association with myxedema, rheumatoid arthritis, and neuropsychiatric and neuromuscular abnormalities (due to a defect in _______ synthesis) has been reported with pernicious anemia

myelin

The so-called ischemia-reperfusion injury is a clinically important process that may contribute significantly to tissue damage in ____________ and _________ ischemia.

myocardial, cerebral

Striated muscle: Each cell is packed with bundles of actin and myosin filaments (____________) that produce contraction.

myofibrils

Normally, despite variations in fluid intake, plasma osmolality is maintained within ______ limits (280-295 mmol/kg H2O).

narrow

Measurements of __________ ________ help to diagnose the cardiac failure.

naturetic peptides

Apoptosis occurs rapidly, with little or no release of proteins that would trigger inflammation, unlike the death of injured cells by _______ that typically induces local inflammation.

necrosis

Under different conditions, __________ in tissues may assume specific patterns: coagulative, liquefactive, gangrenous, caseous, fat, and fibrinoid.

necrosis

damage to membranes is severe, enzymes leak out of lysosomes, enter the cytoplasm, and digest the cell, resulting in _________

necrosis

Morphologic changes in reversible and irreversible cell injury (________). A, Normal kidney tubules with viable epithelial cells. B, Early (_______________) ischemic injury showing surface blebs, increased eosinophilia of cytoplasm, and swelling of occasional cells. C, Necrotic (_______________) injury of epithelial cells, with loss of nuclei and fragmentation of cells and leakage of contents.

necrosis reversible irreversible

There are two types of cell death—__________ and ___________—which differ in their mechanisms, morphology, and roles in disease and physiology

necrosis, apoptosis

Whereas _________ is always a pathologic process, _________ serves many normal functions and is not necessarily associated with pathologic cell injury.

necrosis, apoptosis

Therapy for NUG, NUP, and NS involves debridement (removal of ___________ tissue and __________-__________ irrigation), chlorhexidine rinses, metronidazole, follow-up care, and long-term maintenance.

necrotic, poviodine, iodine

Gram stain preparation of a bronchoalveolar lavage specimen showing gram-_________ intracellular ____ typical of members of Enterobacteriaceae such as Klebsiella pneumoniae or Escherichia coli.

negative, rods

The concentration gradient of Na+ ions and the electric potential (inside ___________) power the import and export of other molecules with Na+ against their concentration gradient by _____________ and ______________, respectively.

negative, symporters, antiporters

Although they generally do not cause clinical dysfunction, extensive calcifications in the lungs may be evident on radiographs and may produce respiratory deficits, and massive deposits in the kidney (__________________) can lead to renal damage.

nephrocalcinosis

ROS are produced in phagocytic leukocytes, mainly ___________ and _____________, as a weapon for destroying ingested microbes and other substances during inflammation and host defense. The ROS are generated in the __________ and ________________ of leukocytes by a process that is similar to mitochondrial respiration and is called the ____________ ________. In this process, a phagosome membrane enzyme catalyzes the generation of ___________, which is converted to ____. This is in turn converted to a highly reactive compound ____________ (the major component of household _______) by the enzyme _______________, which is present in leukocytes.

neutrophils, macrophages, phagosomes, phagolysosomes, respiratory burst, superoxide, H2O2, hypochlorite, bleach, myeloperoxidase

Severe _______ deficiency produces dermatitis, diarrhea and dementia

niacin

Vitamin A deficiency presents as _____ _________

night blindness

______ ______ is another reactive free radical produced in leukocytes and other cells. It can react with hyrdoxyl radical to form a highly reactive compound, peroxynitrite, which also participates in cell injury.

nitric oxide

The relationship among cellular function, cell death, and the morphologic changes of cell injury. Note that cells may rapidly become ________________ after the onset of injury, although they are still viable, with potentially _____________ damage; with a longer duration of injury, ___________ injury and cell _____ may result. Note also that cell death typically comes _______ ultrastructural, light microscopic, and grossly visible morphologic changes.

nonfunctional, reversible, irreversible, death, before

Cytoplasm is separated from nucleoplasm by the _______ ________, a double set of membranes with a narrow perinuclear space; the outer membrane binds ribosomes and is continuous with the RER.

nuclear envelope

The nuclear envelope is penetrated by _______ ____ _________, large assemblies of nucleoporins with 8-fold symmetry through which proteins and protein-RNA complexes move in both directions.

nuclear pore complexes

Mechanism of action of antiretroviral chemotherapeutic agents. This class of inhibitors includes several compounds with slightly different chemical structures in the __________ structure and in substitution at the _′-carbon of the sugar ring. Structures of some of the most widely used drugs are shown. These compounds are metabolized to the ____________ form via normal cellular metabolism. The triphosphate analogues are then incorporated into the viral genome by __________ __________. This blocks viral DNA synthesis because the modified _′ end __ of the viral DNA molecule is not a substrate for additional rounds of DNA synthesis. ___, azido-2′,3′-dideoxythymidine; ___, 2′,3′-dideoxycytidine; ___, 2′,3′-dideoxy-3′-thiacytidine.

nucleobase, 3, triphosphate, reverse transcripatase, 3, R2, AZT, ddC, 3TC

The __________ is a very basophilic or electron-dense area of chromatin localized where rRNA transcription and ribosomal subunits assembly occur.

nucleolus

Balance between the _______ and ___________ pressure changes across the vascular bed and is fundamental for the circulation of substrates and nutrients

oncotic, hydrostatic

There is no reason for an for an AIDS patient to be declined treatment by the dentist, regardless of the practitioner's personal reason. However, if the dentist and the patient agree, the dentist may refer this patient to another provider who is more willing or better suited (in keeping with the patient's ____ ______ status) to provide treatment.

oral health

The anterior two-thirds of the tongue, the '____ tongue', develops from _ swellings: _ _______ ______ ____ (lateral lingual swellings) and a ______ ______ ____ (tuberculum impar)

oral, 3 2 distal tongue buds, median tongue bud

The site at which DNA replication is initiated is termed the ______ __ ____________

origin of replication

In yeast there is a complex called the ______ ___________ _______, composed of six proteins.

origin recognition complex

Differences in __________ cause movement of water between intracellular and extracellular fluid

osmolality

Molecules dissolved in body water contribute to the _______ pressure

osmotic

Movement of water between ECF and ICF is controlled by _______ _________

osmotic gradients

Movement of water between the lumen of a blood vessel and the interstitial fluid is controlled by the _______ and ___________ pressures

osmotic, hydrostatic

Defects in the osteoclast plasma membrane V-ATPase result in ______________ (increased bone density), while mutation of the ATPase in collecting ducts of the kidney causes renal tubular acidosis.

osteopetrosis

Ways of increasing HIV expression: Ex vivo (_______ the body) activation of immune cells, such as cytotoxic T lymphocytes, __________ T cells, or _______ _________ cells, by cytokines or HIV peptides.

outside, gammadelta, natural cytotoxic

Mitochondrial damage may result in several biochemical abnormalities: •Failure of ____________ __________________ leads to progressive depletion of ATP, culminating in necrosis of the cell, as described earlier. •Abnormal oxidative phosphorylation also leads to the formation of _________ _______ __________, which have many deleterious effects, described below. •Damage to mitochondria is often associated with the formation of a ____-conductance channel in the mitochondrial membrane, called the mitochondrial permeability transition pore. The opening of this channel leads to the loss of mitochondrial membrane potential and __ changes, further compromising oxidative phosphorylation. •The mitochondria also contain several proteins that, when released into the cytoplasm, tell the cell there is internal ________ and activate a pathway of ___________.

oxidative phosphorlyation reactive oxygen species high, pH injury, apoptosis

The major causes of hypercalcemia are (1) increased secretion of ______________ hormone, due to either primary ________________ tumors or production of __________________ hormone-related protein by other malignant tumors; (2) destruction of _____ due to the effects of accelerated turnover (e.g., ________ disease), immobilization, or tumors (increased bone catabolism associated with ________ __________, leukemia, or diffuse ____________ metastases); (3) vitamin _-related disorders including vitamin _ intoxication and ______________ (in which _____________ activate a vitamin _ precursor); and (4) ________ failure, in which __________ retention leads to secondary hyperparathyroidism.

parathyroid, parathyroid, parathyroid bone, Padget, multiple myeloma, skeletal D, D, sarcoidosis, macrophages, D renal, phosphate

Cobalamin is released from foods by a gastric protease and HCl. It is bound to the intrinsic factor secreted by the ________ cells in the stomach, and is absorbed in the distal _____ by receptor-mediated endocytosis. Vitamin B12 is excreted in the ____, and there is a marked enterohepatic circulation.

parietal, ileum, bile

Salivary gland development: The _______ gland is the first to be formed and appears near the angles of the developing ______ (stomodeum).

parotid, mouth

The rate of transport of small uncharged molecules via simple diffusion is, in fact, closely related to their _________ ___________ between oil and water.

partition coeffeceint

An example of ____________ cellular hypertrophy is the cardiac enlargement that occurs with hypertension or aortic valve disease

pathologic

Most forms of _____________ hyperplasia are caused by excessive hormonal or growth factor stimulation.

pathologic

It is this responsiveness to normal regulatory control mechanisms that distinguishes ___________ _______________from cancer, in which the growth control mechanisms become dysregulated or ineffective

pathologic hyperplasias

by explaining the causes and development of disease ___________ provides the scientific foundation for the practice of medicine.

pathology

Literally translated, __________ is the study (_____) of disease (______, _______).

pathology, logos, pathos, suffering

Niacin deficiency initially produces a superficial glossitis but may progress to ________, which is characterized by dermatitis, sunburn-like skin lesions in areas of body exposed to sunlight and to pressure, and also by diarrhea, and dementia.

pellagra

Iron defeciency anemia: In men, management often involves treatment of the underlying cause (e.g., ______ ________ disease, ________________ malignancy).

peptic ulcer, gastrointestinal

P-glycoprotein ('P' =_______________) and MRP (__________ __________ ______________), which have a physiologic role in excretion of toxic metabolites and xenobiotics, contribute to resistance of cancer cells to chemotherapy.

permeability, multidrug resistance associated protein

This 38-year-old woman has blue eyes and vitiligo and shows premature graying of the hair—three features that are more common in patients with ________ ________ than in control subjects.

pernicious anemia

Vitamin B12 deficiency causes __________ _______

pernicious anemia

an association with myxedema, rheumatoid arthritis, and neuropsychiatric and neuromuscular abnormalities (due to a defect in myelin synthesis) has been reported with what type of anemia?

pernicious anemia

Vitamin B12 deficiency is characterized by anemia, fatigue, constipation, weight loss, diarrhea and neurological symptoms such as numbness and tingling, loss of balance, confusion, mood disturbances and dementia. Deficiency can occur through several mechanisms. The most common one is ___________ _______, an autoimmune condition that results in gastric atrophy and the lack of the __________ _______, which prevents the vitamin absorption in the terminal ileum

pernicious anemia, intrinsic factor

RXR-type receptors can also interact with other nuclear receptors such as those for vitamin D3, thyroid hormones or __________ ____________ _________ ________ (_____)

peroxisome proliferator activator receptors (PPARs)

Nitric oxide is another reactive free radical produced in leukocytes and other cells. It can react with hyrdoxyl radical to form a highly reactive compound, ____________, which also participates in cell injury.

peroxynitrite

Milder forms of vitamin C deficiency are more common, and their manifestation includes easy bruising and the formation of _________ (small, pinpoint hemorrhages under the skin)

petechiae

Catalytic function of the Na+/K+-ATPase. The catalytic subunit of the Na+/K+-ATPase can be either ______________ (____ and ____) or ______________ (__ and __) and this changes its conformation and affinity towards substrates. The __ form exhibits high affinity towards ATP, magnesium and sodium and low affinity towards potassium, whereas the __ form exhibits high affinity for potassium and low for sodium. After the release of ___, there is conformational change from ____ to ____. This promotes extracellular delivery of ______ and the binding of extracellular _________. The latter process induces ________________ of E2-P and _________ release into the intracellular compartment.

phosphorlyated, E1-P, E2-P, dephosphorlyated, E1, E2, E1, E2, ADP, E1-P, E2-P, sodium, potassium, dephosphorlyation, potassium

SIckle cell screening: •Confirm with patient's ___________ that condition is stable.

physician

The massive ______________ enlargement of the uterus during pregnancy occurs as a consequence of estrogen-stimulated smooth muscle hypertrophy and smooth muscle hyperplasia. In contrast, in response to increased demand the striated muscle cells in both the skeletal muscle and the heart can undergo only hypertrophy because adult muscle cells have a limited capacity to divide. Therefore, the chiseled physique of the avid weightlifter stems solely from the hypertrophy of individual skeletal muscles.

physiologic

The two types of ___________ hyperplasia are (1) hormonal hyperplasia, exemplified by the proliferation of the glandular epithelium of the female breast at puberty and during pregnancy, and (2) compensatory hyperplasia, in which residual tissue grows after removal or loss of part of an organ

physiologic

Atrophy: Although some of these stimuli are _______________ (e.g., the loss of hormone stimulation in menopause) and others ___________ (e.g., denervation), the fundamental cellular changes are identical.

physiologic, pathologic

Hyperplasia can be _____________ or _____________

physiologic, pathologic

Hypertrophy can be ___________ or ___________ and is caused either by increased functional demand or by growth factor or hormonal stimulation.

physiologic, pathologic

Deposition of ____________: typically indigestible pigments, such as carbon, ______________ (breakdown product of lipid peroxidation), or iron (usually due to overload, as in _______________)

pigments, lipofuschin, hemosiderosis

______ _________ damage leads to loss of osmotic balance and influx of fluids and ions, as well as loss of cellular contents. The cells may also leak metabolites that are vital for the reconstitution of ATP, thus further depleting energy stores.

plasma membrane

HIV Virion: The envelope, which is derived from the host cell ________ __________, incorporates the spike glycoproteins _____ and the transmembrane ____, which are associated noncovalently. The envelope may also incorporate host membrane proteins such as ___ class _ and class __ molecules. The _______ protein generates the shape of the virion. The capsid protein ___ forms the nucleocapsid structure that encloses _ copies of genomic RNA. _ molecules of _______ ________________ are bound to the RNA. The nucleocapsid includes the __________ and the ___________. The ___________ cleaves the HIV polyproteins into individual proteins, causing virion maturation following virus budding from the host cell. The _______________ is necessary for the incorporation of the reverse-transcribed HIV DNA genome into the host cell chromosome following infection.

plasma membrane, gp120, gp41, MHC I, II, matrix, p24, 2, 2, reverse transcriptase, protease, integrase, protease, integrase

Capillary vessel wall separates _______ from the surrounding ____________ _____

plasma, interstitial fluid

The values for __________ and _____________ are the same in the very severe form of aplastic anemia as in the severe form, but the ___________ count is less than 200/µL

platelet, reticulocyte, neutrophil

HIV patients may be medicated with drugs that are prophylactic for __________ pneumonia, candidiasis, ______ _______ virus (___) or CMV infection, or other opportunistic disease, and these medications must be carefully considered in dental treatment planning.

pneumocystis, herpes simplex, HSV

HIV: The polymerase, ___, gene encodes RT integrase, and protease.

pol

Pneumococcal pneumonia. Note the intra-alveolar _________________ exudate and intact alveolar _____.

polymorphonuclear, septa

when part of a liver is resected, mitotic activity in the remaining cells begins as early as 12 hours later, eventually restoring the liver to its normal weight. The stimuli for hyperplasia in this setting are _______________ ______ ___________ produced by uninjured hepatocytes as well as ________________ cells in the liver

polypeptide growth factors, nonparenchymal

The A-form is observed when the DNA strands contain tracks of __________ (and complementary _______________) residues

polypurine, polypyrimidine

α-Tocopherol inhibits the activity of ________ ______ _ (___) and affects cell adhesion as well as arachidonic acid metabolism.

protein kinase C, PKC

Gram stain preparation of sputum from a patient with pneumonia. Gram-__________, elongated _____ in _____ and short ______ (Streptococcus pneumoniae) and a neutrophil are evident

positive, cocci, pairs, chains

After a needlestick, the rate of transmission of HIV can be reduced by ____________ ____________ (___)

postexposure prophylaxis, PEP

Monitoring serum _________ concentration is fundamentally important

potassium

Folic acid requirements increase greatly as the blood volume and number of erythrocytes increase in __________

pregnancy

HIV: The double-stranded cDNA is circularized and then complexes with cellular and viral proteins to form a ________________ _________, which is transported through the nuclear pore complex into the nucleus

preintegration complex

Sickle cell: The use of a local anesthetic is acceptable (avoid _____________ and ___________ anesthesia); however, inclusion of small amounts of _____________ in the local anesthetic is controversial in that some authors believe it may impair circulation and cause vascular occlusion

prilocaine, general, epinehperine

Once the strands are sufficiently separated, another protein, termed DNA _______, is added, resulting in the formation of a _________ complex at the replication fork.

primase, primosome

Some chemicals (______________) are not mutagenic per se, but are activated to mutagenic compounds during metabolic processes, e.g. during drug detoxification in liver or kidney.

procarcinogens

The damage caused by free radicals is determined by their rates of ___________ and _________

production, removal

Apoptosis: Cell loss in _______________ cell populations, such as intestinal crypt epithelia, in order to maintain a constant number

proliferating

Stages of mitotic cell divisions include ________, when chromosomes condense, the nuclear envelope disassembles, and the microtubular spindle forms; _________, when chromosomes are aligned; _________, when they begin to separate toward the two centrosomes; and _________, when nuclear envelope re-forms around the separated chromosomes.

prophase, metaphase, anaphase, telophase

In the case of Gag and Pol, the HIV _________ carries out this function within the newly synthesized virion.

protease

midazolam and triazolam should be avoided in patients taking select ________ __________, because benzodiazepine metabolism may be inhibited, leading to excessive sedation and/or respiratory depression

protease inhibitors

The antiretroviral agents available are classified into five categories: ________ _________ (___), ___________ _______ ____________ ___________ (_____), ___-__________ ________ _____________ __________ (______), _______________, and _____ __________

protease inhibitors, PIs nucleoside reverse transcriptase inhibitors, NRTIs non nucleoside reverse transcriptase inhibitors, NNRTIs nucleotides entry inhibitors

Pyridoxine requirements increase with high _______ intake

protein

In normal (immunocompetent) persons, the patterns of host responses are fairly stereotypical for different classes of microbes; these response patterns can be used to infer possible causal organisms. ○Neutrophil-rich acute suppurative inflammation is typical of infections with many bacteria ("__________" bacteria) and some _____. ○Mononuclear cell infiltrates are common in many ________ infections and some acute _____ infections. ○Granulomatous inflammation is the hallmark of infection with Mycobacterium tuberculosis and certain ______.fungi ○Cytopathic and proliferative lesions are caused by some _______. ○Chronic inflammation and scarring represent the final common pathway of many ____________.

pyogenic, fungi chronic, viral fungi viruses infections

The nucleolus is a very basophilic or electron-dense area of chromatin localized where ____ _____________ and _________ ________ assembly occur.

rRNA transcription, ribosomal subunits

The generation of free radicals is increased under several circumstances: •The absorption of _________ _________ (e.g.,UV radiation, X-rays). Ionizing radiation can hydrolyze water into __________ and ____________ free radicals. •The enzymatic metabolism of __________ __________ (e.g., CCl4) •______________, in which free radicals are produced by leukocytes

radiant energy, hydroxyl, hydrogen exogenous chemicals Inflammation

Cells have mechanisms that repair damage to DNA, but if this damage is too severe to be corrected (e.g., after ____________ injury or __________ _______), the cell initiates its suicide program and dies by apoptosis

radiation, oxidative stress

Viral opportunistic infctions in AIDS patients: •Persistent mucocutaneous herpes simplex virus infection •Cytomegalovirus retinitis or disseminated virus infection •Persistent or disseminated varicella zoster virus infection •Progressive multifocal leukoencephalopathy (___________ ___ _____) •Molluscum contagiosum poxvirus •Epstein-Barr virus hairy leukoplakia

reactivated JC virus

the products formed by oxidative metabolism include ________ ______ _________, which can injure the cell.

reactive oxygen species

Meperidine should be avoided in patients taking _________, because _________ increases the metabolism of meperidine to normeperidine which is associated with adverse effects such as lethargy, agitation, and seizures.

ritonavir, ritonavir

ROS are produced normally in small amounts in all cells during the reduction-oxidation (_____) reactions that occur during mitochondrial respiration and energy generation. In this process, molecular oxygen is sequentially reduced in mitochondria by the addition of four electrons to generate water. This reaction is imperfect, however, and small amounts of highly reactive but short-lived toxic intermediates are generated when oxygen is only partially reduced. These intermediates include ______________, which is converted to hydrogen peroxide (____) spontaneously and by the action of the enzyme __________ _____________. H2O2 is more stable than and can cross biologic membranes. In the presence of metals, such as ____, H2O2 is converted to the highly reactive ___________ radical •OH by the ______ reaction.

redox, superoxide, H2O2, superoxide dismutase, Fe2+, hydroxyl, Fenton

Cancer treatment news: two new protein targets to counteract '_______' and '____ ___________'

relapse, drug resistance

8-Oxo-2′-deoxyguanosine is eliminated via _____ ___________

renal filtration

Glucose is reabsorbed primarily by sodium glucose transporter 2 (SGLT2; one-to-one Na+: Glc stoichiometry) into______ _________ ___________ epithelial cells.

renal proximal tubular

The ____-___________-____________ system plays a central role in the regulation of circulating volume, extracellular fluid osmolality and blood pressure

renin angiotensin aldosterone

The _____-___________-___________ system is the principal regulator of the blood pressure and vascular tone

renin angiotensin aldosterone

Renin-Angiotensin Pathway: Another signaling pathway involving the G-proteins and an increase in cytosolic calcium decreases the activity of the adenylate cyclase and inhibits _____ secretion (this pathway is activated by ____________ __, and ___________ _ and __).

renin, angiotensin II, endothelins I, II

_____ is produced in the juxtaglomerular apparatus of the kidney upon decrease of circulating volume, and it converts _________________ produced in the _____ to ___________ _

renin, angiotensinogen, liver, angiotensin I

The replication of DNA is a complex, stringently regulated process. DNA is essentially the only polymer in the body that is _________, rather than _________, following chemical or biological modification. Repair mechanisms generally involve excision of modified _____ and replacement, using the ____________ strand as a template.

repaired, degraded, bases, unmodified

Eukaryotes stringently regulate DNA ___________

replication

Infections of the keratinized skin, hair, and nails by fungi are classified as cutaneous mycoses and are caused by dermatophytes, which include the genera Epidermophyton, Trichophyton, and Microsporum. The symptoms include itching, scaling, ringlike patches on the skin (called "________," although they have nothing to do with worms), and discolored nails.

ringworm

DNA synthesis occurs at a ___________ ____ producing new strands termed the ________ strand and the _______strand. The 'railroad tracks' represent ______-stranded DNA. Some of the enzymes involved in DNA synthesis are shown: DNA _ (________), DNA _______, DNA __________, and _______-strand DNA _______ protein (____). The _________ strand is replicated in a continuous fashion. However, for the _______ strand, ___ primers are periodically added by the DNA _______ along the strand. DNA __________ ___ elongates these RNA primers to form _________ _________. When the _______ ________ is complete, the DNA __________ ___ on the ________ strand will shift to the next RNA primer to initiate another Okazaki fragment. The ___________ activity of DNA __________ _ removes the RNA primers and replaces them with ___. DNA ______ seals the gaps in the DNA strands to complete synthesis of the ___________ strand.

replication fork, leading, lagging, double, B, primase, polymerase, single, binding, SSBP, leading, lagging, RNA, primase, polymerase III, Okazaki fragments, Okazaki fragment, polymerase III, lagging, exonuclease, Polymerase I, DNA, ligase, lagging

All normal cells have a limited capacity for replication, and after a fixed number of divisions cells become arrested in a terminally nondividing state, known as ____________ _____________. Aging is associated with progressive replicative senescence of cells. Cells from children have the capacity to undergo more rounds of replication than do cells from older people. In contrast, cells from patients with _______ __________, a rare disease characterized by premature aging, have a markedly reduced in vitro life span. In human cells, the mechanism of replicative senescence involves progressive shortening of telomeres, which ultimately results in cell cycle arrest. ___________ are short repeated sequences of DNA present at the ends of linear chromosomes that are important for ensuring the complete replication of chromosome ends and for protecting the ends from fusion and degradation. When somatic cells replicate, a small section of the telomere is not duplicated, and telomeres become progressively shortened. As the telomeres become shorter, the ends of chromosomes cannot be protected and are seen as broken DNA, which signals cell cycle arrest. Telomere length is maintained by nucleotide addition mediated by an enzyme called _____________. Telomerase is a specialized RNA-protein complex that uses its own RNA as a template for adding nucleotides to the ends of chromosomes. Telomerase activity is expressed in germ cells and is present at low levels in stem cells, but it is absent in most somatic tissues. Therefore, as most somatic cells age their telomeres become shorter and they exit the cell cycle, resulting in an inability to generate new cells to replace damaged ones. Conversely, in immortalized cancer cells, telomerase is usually reactivated and telomere length is stabilized, allowing the cells to proliferate indefinitely. Telomere shortening may also decrease the regenerative capacity of stem cells, further contributing to cellular aging. Despite such alluring observations, however, the relationship of telomerase activity and telomere length to aging has yet to be fully established.

replicative sensencnce, Werner syndrome, telomeres, telomerase

HIV: Monocytes, macrophages, and dendritic cells, as well as memory T cells that get infected later, act as __________ of the virus

reservoirs

HAART reduces the likelihood of the development of drug __________ and can reduce the blood levels of HIV to _____________ levels.

resistance, undetectable

Cells of adipose tissue are supported by ________ fibers, with ____________ tissue septa dividing the tissue into _________ of various sizes.

reticular, connective, lobules

Structure, metabolism and function of vitamin A. Conversion of _____________ to retinoic acid is irreversible

retinaldehyde

Structure, metabolism and function of vitamin A. Conversion of retinaldehyde to ________ ____ is irreversible

retinoic acid

Retinoic acid is thought to be transported to cells bound to either albumin or to a specific ________ ____ _______ _______ (____)

retinoic acid binding protein, RABP

All dietary forms of vitamin A are converted to _______

retinol

Conversion of carotenoids to vitamin A is rarely 100% efficient and the potency of foods is described in _______ ________ ___________ (___); 1 µg of retinol is equivalent to 12 µg β-carotene, or 24 µg of other carotenes.

retinol activity equivalents, RAEq

In 1983, a ____________ (later named the human immunodeficiency virus [___]) was isolated from a patient with AIDS.

retrovirus, HIV

AIDS is caused by HIV, a nontransforming ___________ of the __________ family

retrovirus, lentivirus

HIV: Once it enters the cytoplasm, the viral RNA genome is ________ ______________ by RT; a complementary, negative-strand DNA (_____) is produced; and the RNA template is degraded by the ____________ _ activity of the RT

reverse transcribed, cDNA, ribonuclease H

Several important antiviral drugs are nucleotide analogues that inhibit ________ ___________, including AZT (azido-2′,3′-dideoxythymidine; Retrovir, zidovudine), ddC (2′,3′-dideoxycytidine; Hivid, zalcitabine), and 3TC (2′,3′-dideoxy-3′-thiacytidine; Epivir, lamivudine)

reverse transcripatse

an RNA-dependent DNA polymerase, was first described by David Baltimore, Howard Temin, and Satoshi Mizutani in 1970 and termed ________ _____________

reverse transcriptase

Riboflavin is attached to the sugar alcohol _______. The molecule is colored, fluorescent and decomposes in visible light but is heat stable. It is found in the oxidoreductases such as the ______ ______________ (___) and the ______ ________ _____________ (___), and is required for the energy metabolism of both carbohydrates and lipids

ribitol, flavin mononucleotide, FMN, flavin adenine dinucleotide, FAD

Lack of ___________ in the diet causes a deficiency syndrome of inflammation of the corners of the mouth (angular stomatitis), the tongue (glossitis) and scaly dermatitis

riboflavin

Deficiency of vitamin D produces _______ in children and ____________ in adults

rickets, osteomalacia

Biomembranes are not _____ or _____________, but highly _______ and _________ structures

rigid, impermeable, dynamic, mobile

HIV drug: Protease inhibitors such as _________ and _________ block the cleavage of the Gag and Gag-Pol polyproteins, thereby preventing the maturation of the virus structure

ritonavir, indinavir

The dentist can undertake diagnostic laboratory screening using ______ (Oraquick Advance; OraSure Technologies, Inc., Bethlehem, Pennsylvania), or _____ testing can be done with a referral to a medical facility

saliva, serum

Fat necrosis in acute pancreatitis. The areas of white chalky deposits represent foci of fat necrosis with calcium soap formation (______________) at sites of lipid breakdown in the mesentery.

saponification

The primary fungal pathogens that can infect apparently healthy, immunocompetent hosts and avoid the immune system include Blastomyces dermatitidis, H capsulatum, C immitis, and Paracoccidioides brasiliensis. These pathogens have both a ___________ phase, in which they produce hyphae that generate the infectious cells, and a ____________ phase, in which they reproduce in the hospitable environment of the respiratory epithelium. This dimorphism is considered to be one of the ___________ ________ of these microorganisms.

saprobic, parasitic virulence factors

Muscle contraction: The escape of Ca2+ from the lumen (interior compartment) of the ____________ _____________ increases the cytoplasmic concentration of Ca2+ (depolarization-induced Ca2+ release) about ___-fold, from 10−4 mmol/L (0.0007 mg/L) to about 10−2 mmol/L (0.07 mg/dL), triggering ___ hydrolysis by _________, which initiates muscle contraction

sarcoplasmic, 100, ATP, myosin

Because these repetitive sequences cover long stretches of chromosomes (100s to 1000s of kilobase pairs; kbp), determining the sequence of __________ DNA and sequencing the ___________ region of DNA are major challenges to completing the non-coding sequence of eukaryotic genomes.

satellite, centromere

Protein-mediated transport is a ______________ process with high substrate ______________.

saturable, specificity

Vitamin C deficiency causes ______ and compromises ______ function

scurvy, immune

Uniport, symport, and antiport are examples of _________ ______ transport

secondary active

Autophagy AKA

self eating

Lymphocytes capable of recognizing self antigens are normally produced in all individuals. If these lymphocytes encounter ____ antigens, the cells die by _____________. Both the mitochondrial pathway and the Fas death receptor pathway have been implicated in this process

self, apoptosis

Evidence suggests that persons most susceptible to developing AIDS are those with repeated exposure to the virus who also have an immune system that has been challenged by repeated exposure to various antigens (_____, _________ _, and _____ products)

semen, hepatitis B, blood

Genetic information is replicated by a ____-____________ mechanism in which the parental strands are separated and both act as templates for daughter DNA.

semi conservative

The mitochondrial pathway of apoptosis. The induction of apoptosis by the mitochondrial pathway is dependent on a balance between pro- and anti-apoptotic proteins of the ___ family. The pro-apoptotic proteins include some (_________) that sense DNA and protein damage and trigger apoptosis and others (___________) that insert in the mitochondrial membrane and promote leakage of mitochondrial proteins. A, In a viable cell, ____-apoptotic members of the Bcl-2 family prevent leakage of mitochondrial proteins. B, Various injurious stimuli activate cytoplasmic ___________ and lead to reduced production of these anti-apoptotic proteins and increased amounts of pro-apoptotic proteins, resulting in leakage of proteins that are normally sequestered within mitochondria. The mitochondrial proteins that leak out activate a series of _____________, first the _____________ and then the __________________, and these enzymes cause fragmentation of the nucleus and ultimately the cell.

sensors, effectors sensors, caspases initiators, executioners,

Na+/K+-ATPase (the ______-_________ ____) generates transmembrane potential and ion concentration gradients across the cell membrane. The transmembrane difference in ______ concentration (ΔNa+), and transmembrane _______ difference (ΔV) are shown on the right. For each molecule of hydrolyzed ___, it moves _ potassium ions ____ the cell and _ sodium ions ___ __ the cell. Na+/K+-ATPase consists of _ main subunits - catalytic subunit (______) and structural subunit (____).

sodium potassium pump, sodium, voltage, ATP, 2, into, 3, out of, alpha, beta

Na+/K+-ATPase can be considered either as an ion transporter (______ ____) or as an enzyme (______). It maintains chemical and electrical potential gradients (it is ____________) across the cell membrane

sodium pump, ATPase, electrogenic

Aldosterone regulates ______ and _________ homeostasis

sodium, potassium

Na+/K+-ATPase maintains the ______ and _________ gradients across the cell membrane

sodium, potassium

Major minerals present in the human body are ______, _________, ________, _________, _______, and _________

soidum, potassium, calcium, phosphate, chloride, magnesium

There may be finite limits of the vasculature to adequately supply the enlarged fibers, of the mitochondria to supply adenosine triphosphate (ATP), or of the biosynthetic machinery to provide the contractile proteins or other cytoskeletal elements. The net result of these changes is ventricular dilation and ultimately cardiac failure, a sequence of events that illustrates how an adaptation to ________ can progress to functionally significant cell _______ if the stress is not relieved.

stress, injury

B12/Folate Defeciency: A neurologic presentation can also develop in the absence of anemia. This is known as ________ ________ ____________ __ ___ ____ and is probably secondary to a relative deficiency of __________ in the cord.

subacute combined degeneration of the cord, methionine

When the concentration of extracellular molecules (transport _____________) becomes very high, the ____ is achieved by saturation of the transport proteins with substrate.

substrates, Tmax

The ATP-sensitive K+ channel (KATP) participates in regulation of insulin secretion in pancreatic islet β-cells. When the blood concentration of glucose increases, glucose is transported into the β-cell through a glucose transporter (GLUT-2) and metabolized, resulting in an increase in cytoplasmic ATP concentration. The ATP binds to the regulatory subunit of the K+ channel, KATP-β (called the ____________ __________) causing structural change of a KATP-alpha subunit, which closes the KATP channel. This induces depolarization of the plasma membrane (_____________ voltage gradient across the membrane) and activates voltage-dependent calcium (____) channels (______). The entry of Ca2+ stimulates exocytosis of vesicles that contain insulin.

sulfonylurea receptor, decreased, Ca2+, VDCCs

Pathways of production of reactive oxygen species. A, In all cells, _____________ (O2•) is generated during mitochondrial respiration by the electron transport chain and may be converted to ______ and the _________ (•OH) free radical or to ____________ (ONOO−). B, In leukocytes (mainly _____________ and _______________), the phagocyte oxidase enzyme in the phagosome membrane generates _____________, which can be converted to other free radicals. ________________ (___) in phagosomes also generates ____________ from reactive oxygen species (____).

superoxide, H2O2, hydorxyl, peroxynitrite neutrophils, macrophages, superoxide, myeloperoxidase, MPO, ROS

The functional consequences may be severe at this stage. For instance, heart muscle ceases to contract within 60 seconds of coronary occlusion. If hypoxia continues, worsening ATP depletion causes further deterioration, with loss of microvilli and the formation of "blebs". At this time, the entire cell and its organelles (mitochondria, ER) are markedly __________, with ____________ concentrations of water, sodium, and chloride and a ____________ concentration of potassium. If oxygen is restored, all of these disturbances are ____________, and in the case of myocardium, contractility returns.

swollen, increased, decreased, reversible

Prophase of the first meiotic division is a unique, extended period in which homologous chromosomes pair and undergo genetic recombination during the process called ________

synapsis

an excessive secretion of vasopressin may occur following major trauma or surgery. This is known as the ________ __ ______________ ____________ _______ _________, and leads to water retention. Mutations in the vasopressin receptor gene and also in the AQP2 gene lead to different types of ___________ _________ __________, a condition associated with passing large amounts of urine and with dehydration.

syndrome of inappropriate antidiuretic hormone, nephrogenic diabetes insipidus

Fatty change: accumulation of free triglycerides in cells, resulting from excessive intake or defective transport (often because of defects in __________ of ___________ proteins); manifestation of reversible cell injury

synthesis, transport

Some fungi, including Histoplasma capsulatum and Coccidioides immitis, cause ________ _______ that start with infection of the lungs and then spread to other parts of the body.

systemic mycoses

During the synthesis of telomeres, the enzyme __________, a ribonucleoprotein complex, adds preformed hexanucleotide repeats to the 3′-end of the chromosome, using its RNA as a template; there is no requirement for a DNA template

telomerase

Trauma, extremes of ____________, radiation, ________ shock, and sudden changes in ___________ pressure all have wide-ranging effects on cells

temperature, eletric, atmospheric

The recommended basic regimen for HIV PEP is _________ plus _______________ or ___________ plus _________.

tenofovir, entricitabine, zevudine, lamivudine

There are two types of adipose tissue: _____ fat and _____ fat.

white, brown

Fatty acids released in adipocytes of brown fat are metabolized in mitochondria of these cells for ________________ rather than ATP synthesis, using _________ _______-_

thermogeesis, uncoupling protein 1

Patients with severe _______________ may require special measures (platelet replacement) before ________ procedures (including scaling and curettage) are performed.

thrombocytopenia, surgical

UV light produces _______ ______: __________ ________ repair

thymine dimers, nucleotide excision

AZT, for example, is metabolized in the body into the ________ ____________ analogue azido-TTP.

thymine triphosphate

After bypassing host _______ barriers, infectious microorganisms must also evade host _______ and ___________ immunity mechanisms to successfully proliferate and be transmitted to the next host. Strategies include: •Antigenic variation •Inactivating antibodies or complement •Resisting phagocytosis (e.g., by producing a capsule) •Suppressing the host adaptive immune response (e.g., by inhibiting MHC expression and antigen presentation)

tissue, innate, adaptive

Structure of vitamin E family (___________). __-__ can be __________ in a variety of combinations. R4 is a polyisoprenoid chain.

tocopherols, R1, R3, methylated

Metaplasia is thought to arise by reprogramming of stem cells to differentiate along a new pathway rather than a phenotypic change (_____________________) of already differentiated cells.

transdifferentitation

Some middle repetitive DNA consists of genes that specify ________ and ___________ ribonucleic acids, which are involved in _______ synthesis, and histone proteins that are part of the __________

transfer, ribosomal, protein, nucleosome

Iron is transported in plasma bound to ___________

transferrin

Cells committed to differentiate (_______ __________ or ___________ cells) typically divide more rapidly than stem cells before slowing or stopping division to differentiate.

transit amplifying, progenitor

When p53 is mutated or absent (as it is in certain cancers), cells with damaged DNA that would otherwise undergo apoptosis survive. In such cells, the DNA damage may result in mutations or DNA rearrangements (e.g., _______________) that lead to neoplastic transformation

translocations

Prevention of HIV infection requires a number of approaches: • Educating the population as to how HIV is _____________ and explaining prevention measures, such as the practicing of safe ___, the proper use of _______, ___________ relationships, and not sharing or reusing _______. • Screening ____, _____ products, and ______ for HIV. • _________-control measures, including universal precautions based on the assumption that all patients are infectious for HIV. These include wearing protective gloves, mask and gown, and other barriers to prevent exposure to ______ products. Contaminated surfaces should be disinfected with __% household bleach, __% ethanol or iso-propanol, _% glutaraldehyde, and _% formaldehyde (or _% hydrogen peroxide). • Use of ______________ creams with anti-HIV drugs and male circumcision. These procedures only reduce the risk of infection.

transmitted, sex, condoms, monogamous, needles blood, blood, organs infection, blood, 10, 70, 2, 4, 6

Most of the permeability properties of the membrane are determined by ___________ proteins, which are ___________ membrane proteins.

transport, integral

Numerous substrates such as ions, nutrients, small organic molecules including drugs and peptides, and proteins are transported by various ____________.

transporters

Facilitated diffusion is catalyzed by _____________ that permit the movement of ions and molecules down ______________ ___________, whereas uphill or active transport requires energy.

transporters, concentration gradients

depolarizaiton of a muscle fiber--> the signal moves rapidly through invaginations in the plasma membrane called the _________ __________, which extend around the myofibrils

transverse tubules

If red or purple lesions in the mouth are found that cannot be explained by history (e.g., ______, ____, ________, ________) or proved by clinical observation (healing within _ to __ days), biopsy is indicated

trauma, burn, chemical, physical, 7, 10

Not surprisingly, rapidly dividing cells have high requirements for folate since it is necessary for the synthesis of purines and pyrimidine thymine, all required for DNA synthesis (Chapter 31). Structural analogues of folate exhibit selective toxicity towards rapidly growing cells such as bacteria and cancer cells. This is the principle behind the development of drugs known as the folic acid antagonists, which are used as antibiotics (e.g. ____________) and anticancer agents (____________)

trimethoprim, methotrexate

The thyroid gland develops between the median tongue bud (__________ ______) and the copula (on day __ of intra-uterine life).

tuberculum impar, 24

Vasopressin binds to a receptor located on the membranes of _______ cells in the __________ _____. The receptor is coupled to _-________ and activates ___. The PKA phosphorylates _________ _. This stimulates AQP2's translocation to the cell membrane, __________ water reabsorption in the collecting duct.

tubular, collecting duct, G proteins, PKA, aquaporin 2, increases

Many cells express surface molecules, called death receptors, that trigger apoptosis. Most of these are members of the _____ ________ ______ receptor family, which contain in their cytoplasmic regions a conserved "death domain," so named because it mediates interaction with other proteins involved in cell death.

tumor necrosis factor

The cellular response to injurious stimuli depends on the _____ of injury, its ________, and its _________. Thus, low doses of toxins or a brief duration of ischemia may lead to reversible cell injury, whereas larger toxin doses or longer ischemic intervals may result in irreversible injury and cell death.

type, duration, severity

The number of viral RNA copies per milliliter of plasma is termed the _____ ____

viral load

The consequences of an injurious stimulus depend on the ____, ________, ________________, and ___________ makeup of the injured cell. The same injury has vastly different outcomes depending on the cell type; thus, striated skeletal muscle in the leg accommodates complete ischemia for 2 to 3 hours without irreversible injury, whereas cardiac muscle dies after only 20 to 30 minutes. The nutritional (or ___________) status can also be important; clearly, a glycogen-replete hepatocyte will tolerate ischemia much better than one that has just burned its last glucose molecule. Genetically determined diversity in metabolic pathways can contribute to differences in responses to injurious stimuli. For instance, when exposed to the same dose of a toxin, individuals who inherit variants in genes encoding cytochrome P-450 may catabolize the toxin at different rates, leading to different outcomes. Much effort is now directed toward understanding the role of genetic polymorphisms in responses to drugs and toxins. The study of such interactions is called pharmacogenomics. In fact, genetic variations influence susceptibility to many complex diseases as well as responsiveness to various therapeutic agents. Using the genetic makeup of the individual patient to guide therapy is one example of "personalized medicine."

type, status, adaptiblility, genetic, hormonal

atrophy: The degradation of cellular proteins occurs mainly by the _________-__________ pathway. Nutrient deficiency and disuse may activate ubiquitin ligases, which attach multiple copies of the small peptide ubiquitin to cellular proteins and target them for degradation in proteasomes. This pathway is also thought to be responsible for the accelerated proteolysis seen in a variety of catabolic conditions, including the cachexia associated with cancer.

ubiquitin proteasome

When short-wavelength ___________ light interacts with DNA, adjacent thymine bases undergo an unusual dimerization, producing a cyclobutylthymine dimer in the DNA strand

ultraviolet

If unfolded or misfolded proteins accumulate in the ER because of inherited mutations or environmental perturbations, they induce a protective cellular response that is called the _________ ________ _________

unfolded protein response

Transport processes may be classified into three general types: ________ (monoport), _________ (cotransport) and ___________ (countertransport)

uniport, symport, antiport

People with the sickle cell trait generally have no symptoms unless they encounter situations in which abnormally low concentrations of oxygen are present (e.g., in an __________________ airplane, through the injudicious administration of ________ ____________).

unpressurized, general anesthesia

Although C immitis endospores are phagocytosed readily by alveolar macrophages, they can survive in phagosomes, producing an alkaline layer resulting from the production of ammonia or ammonium ions. It is thought that a fungal intracellular _______ is involved in the production of ammonia.

urease

Sickle cell anemia may cause various complications. A, Leg ulcer secondary to a _______________ attack. B, Growth deformation of the middle finger from ______________ of the growth plate.

vasoocclusive dacytlitis

The main regulators of water and electrolyte balance are ___________ (water) and _____________ (sodium and potassium).

vasopressin, aldosterone

Defects in ___________ secretion and mutations of genes coding for __________ cause clinical conditions

vasopressin, aquaporins

The severity of the initial acute infection with HIV (i.e., level of _______) is predictive of the course the infection will follow

viremia

A pathogen can establish infection if it possesses _________ _______ that overcome normal host defenses or if the host defenses are compromised.

virulence factors

Diseases caused by microbes involve an interplay of microbial __________ and ____ responses: ○Infectious agents can cause cell death or dysfunction by directly interacting with the cell. ○Injury may be due to local or systemic release of bacterial products, including endotoxins (___), exotoxins, or superantigens. ○Pathogens can induce immune responses that cause tissue damage. Absence of an immune response may reduce the damage induced by some infections; conversely, immunocompromise can allow uncontrolled expansion of opportunistic agents or of microorganisms that can directly cause injury.

virulence, host LPS

Membrane depolarization opens up ________ dependent ion channels at the neuromuscular junction

voltage

voltage changes and ligand binding induce conformational changes in channel structure that have the effect of opening or closing the channels - processes known as ________ or _______-_______

voltage, ligand gating

HDAC Inhibitors such as __________, panobinostat, and romidepsin are being tested in clinical trials.

vorinostat

With the exception of vitamin B12 the body has no storage capacity for _____-soluble vitamins.

water

Osmotic pressure controls the movement of _____ between compartments. An ________ in ECF osmolality draws water from the cells, and leads to cellular dehydration. On the other hand, when ECF osmolality ________, water moves into the cells and this may cause cell edema.

water increases decreases

Assessment of ______ and ___________ status is an important part of clinical practice

water, electrolyte

Historically, textbooks of biochemistry (and many biochemistry courses) have treated _____ and ___________ balance somewhat peripherally.

water, electrolyte

The kidney plays important parts in preservation of ______ and _____________ homeostasis

water, electrolyte

β-Carotene is _____ soluble and is found in _____ food

water, plant

The main regulators of water and electrolyte balance are vasopressin (_____) and aldosterone (______ and _________)

water, sodium, potassium

Gangrenous necrosis is not a distinctive pattern of cell death, the term is still commonly used in clinical practice. It usually refers to the condition of a limb, generally the lower leg, that has lost its blood supply and has undergone coagulative necrosis involving multiple tissue layers. When bacterial infection is superimposed, coagulative necrosis is modified by the liquefactive action of the bacteria and the attracted leukocytes (resulting in so-called ___ ________)

wet gangrene

Adipocytes of _____ fat are typically very large cells, ranging in diameter from 50 to 150 μm.

white

Hyperplasia also is an important response of connective tissue cells in wound healing, in which proliferating fibroblasts and blood vessels aid in repair. In this process, growth factors are produced by _____ ______ cells responding to the injury and by cells in the extracellular matrix.

white blood