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Questions and Answers

What role does Vascular Endothelial Growth Factor (VEGF) play in the process of angiogenesis?

  • It stimulates the growth of new blood vessels. (correct)
  • It inhibits blood vessel growth.
  • It breaks down collagen in scar tissue.
  • It promotes fibroblast activation.

What characterizes the tissue formation during second intention healing?

  • Large scars develop due to inability to approximate edges. (correct)
  • Edges of the wound can be directly approximated.
  • Scar tissue forms without inflammation.
  • Epithelial regeneration is the primary mechanism.

What is the primary function of myofibroblasts in scar maturation?

  • They have contractile proteins that pull wound edges together. (correct)
  • They inhibit collagen production.
  • They produce fibrin to promote clotting.
  • They secrete inflammatory cytokines.

Which type of scar is beyond the borders of the original wound and contains disorganized collagen?

<p>Keloid (B)</p> Signup and view all the answers

What defines exudate compared to transudate in terms of fluid accumulation?

<p>Exudate is a protein-rich fluid resulting from inflammation. (A)</p> Signup and view all the answers

What is a key factor in the development of hydrothorax?

<p>Fluid accumulation in the thoracic cavity. (A)</p> Signup and view all the answers

What is the predominant mechanism leading to edema during hyperemia?

<p>Active vasodilation delivering more blood to tissues. (C)</p> Signup and view all the answers

Which statement about hypertrophic scars is true?

<p>They have type III collagen arranged in parallel. (A)</p> Signup and view all the answers

What is the primary function of the urea cycle?

<p>Conversion of ammonia to urea for excretion (D)</p> Signup and view all the answers

Which condition is characterized by elevated ammonia due to enzyme defects in the urea cycle?

<p>Primary hyperammonemia (B)</p> Signup and view all the answers

What is the primary role of glutamine in the context of ammonia transport?

<p>To carry NH4+ to the liver (B)</p> Signup and view all the answers

What deficiency can lead to megaloblastic anemia and neural tube defects?

<p>Folate (Vitamin B9) (C)</p> Signup and view all the answers

Which of the following symptoms is NOT associated with severe cases of hyperammonemia?

<p>Glossitis (B)</p> Signup and view all the answers

What can be a consequence of a deficiency in cobalamin (Vitamin B12)?

<p>Secondary folate deficiency (D)</p> Signup and view all the answers

Which substance is a competitive inhibitor of dihydrofolate reductase (DHFR)?

<p>Methotrexate (A)</p> Signup and view all the answers

What is a diagnostic marker for folate deficiency after histidine ingestion?

<p>FIGLU in urine (D)</p> Signup and view all the answers

How does hyperammonemia affect glutamate levels in the body?

<p>It lowers glutamate levels due to conversion to glutamine (A)</p> Signup and view all the answers

What role does tetrahydrofolate (THF) play in one-carbon metabolism?

<p>It facilitates the transfer of one-carbon groups (C)</p> Signup and view all the answers

What is the primary role of S-Adenosylmethionine (SAM) in metabolism?

<p>Methyl-group donation (B)</p> Signup and view all the answers

Which enzyme deficiency leads to classic homocystinuria?

<p>Cystathionine beta-synthase (CBS) (A)</p> Signup and view all the answers

Which glucose transporter is insulin dependent and primarily found in muscle and adipose tissue?

<p>GLUT4 (B)</p> Signup and view all the answers

How does ATP influence insulin release from beta islet cells?

<p>It leads to depolarization of the cell membrane. (D)</p> Signup and view all the answers

What role do incretins like GIP and GLP-1 play in glucose metabolism?

<p>They enhance insulin secretion. (C)</p> Signup and view all the answers

What condition is primarily characterized by polyuria, polydipsia, and polyphagia?

<p>Type 1 Diabetes (C)</p> Signup and view all the answers

What is a major consequence of excessive glucocorticoids in diabetes pathophysiology?

<p>Increased gluconeogenesis (A)</p> Signup and view all the answers

What damage is associated with advanced glycation end products (AGE) in diabetes?

<p>Enhanced oxidative stress (B)</p> Signup and view all the answers

What is the primary effect of the hexosamine pathway activation in hyperglycemia?

<p>Exacerbated end organ damage (D)</p> Signup and view all the answers

What type of arteriosclerosis is associated with diabetes and increases the risk of neuropathy?

<p>Hyaline arteriosclerosis (B)</p> Signup and view all the answers

What is the role of sorbitol in diabetic neuropathy?

<p>It accumulates and leads to neuronal damage. (B)</p> Signup and view all the answers

Which of the following best describes the pathway through which glucose converts to fructose and acts as a primary energy source for spermatozoa?

<p>Polyol Pathway (A)</p> Signup and view all the answers

What is the consequence of glucose-6-phosphate dehydrogenase (G6PD) deficiency?

<p>Hemolytic anemia (D)</p> Signup and view all the answers

What is the most common enzyme deficiency found globally and is linked to increased resistance to falciparum malaria?

<p>G6PD deficiency (B)</p> Signup and view all the answers

Which condition is characterized by caloric deficiency that leads to muscle wasting and fat emaciation?

<p>Marasmus (B)</p> Signup and view all the answers

Which of the following is NOT a precipitating factor for hemolytic anemia in G6PD deficiency?

<p>Iron overload (C)</p> Signup and view all the answers

Which of the following characterizes the metabolic state during fatty acid synthesis?

<p>Utilizes acetyl-CoA and ATP (A)</p> Signup and view all the answers

Which cellular adaptation refers to the increase in cell number due to growth factors?

<p>Hyperplasia (D)</p> Signup and view all the answers

What is the primary characteristic of purulent inflammation?

<p>High protein content with many neutrophils (A)</p> Signup and view all the answers

What does the term 'dysplasia' refer to in cellular adaptation?

<p>Pre-neoplastic change of disordered growth (C)</p> Signup and view all the answers

Which nutrient deficiency is primarily linked with the edema seen in Kwashiorkor?

<p>Protein (B)</p> Signup and view all the answers

What condition describes the life-threatening inflammation secondary to a severe infection?

<p>Sepsis (C)</p> Signup and view all the answers

What mechanism leads to reperfusion injury?

<p>Restoration of blood flow causing oxidative stress (D)</p> Signup and view all the answers

Which of the following is NOT a hallmark of chronic inflammation?

<p>Presence of neutrophils (C)</p> Signup and view all the answers

What is the primary role of the complement system in immune response?

<p>Pathogen destruction through a cascade of reactions (A)</p> Signup and view all the answers

What best describes the terms 'serous' and 'fibrinous' in relation to inflammation exudates?

<p>Serous is protein-poor while fibrinous is protein-rich (B)</p> Signup and view all the answers

What characterizes an Acute Hemolytic Transfusion Reaction (AHTR)?

<p>Fever, chills, and DIC due to immune-mediated lysis (A)</p> Signup and view all the answers

Which blood product is most likely to cause Transfusion Related Acute Lung Injury (TRALI)?

<p>Fresh Frozen Plasma (FFP) (C)</p> Signup and view all the answers

What is required for the development of hereditary cancer in tumor suppressor genes?

<p>One germline mutation and one somatic event (B)</p> Signup and view all the answers

What does the Skipper’s Log-Kill Hypothesis state regarding anticancer drugs?

<p>Each dose reduces the tumor mass by a fixed percentage (C)</p> Signup and view all the answers

Which characteristic defines a malignant tumor such as sarcoma?

<p>Arises from solid mesenchymal tissues (A)</p> Signup and view all the answers

What is a common symptom of anemia resulting from blasts in acute leukemia?

<p>Pancytopenia (B)</p> Signup and view all the answers

Which of the following describes the mechanism of an Anaphylactic Transfusion Reaction?

<p>IgE mediated response to donor plasma proteins (B)</p> Signup and view all the answers

What is the primary defect in Myelodysplastic Syndrome?

<p>Ineffective hematopoiesis due to abnormal progenitors (B)</p> Signup and view all the answers

Which genetic event leads to the activation of proto-oncogenes into oncogenes?

<p>One activation event (A)</p> Signup and view all the answers

Which type of blood disorder is characterized by elevated WBC counts without the presence of blast cells?

<p>Chronic Leukemia (D)</p> Signup and view all the answers

What is a typical finding in tumors that produce a mass effect?

<p>Space-occupying lesions that destroy normal tissue (B)</p> Signup and view all the answers

What characteristic of tumors is related to the Warburg effect?

<p>Utilization of aerobic glycolysis for cell replication (A)</p> Signup and view all the answers

What are biomarkers of cancer useful for?

<p>Suggesting potential neoplasms before biopsy (B)</p> Signup and view all the answers

Flashcards

Urea Cycle

The process of converting ammonia to urea for excretion, primarily happening in the liver.

Hyperammonemia

High levels of ammonia in the blood, often caused by problems with the urea cycle.

Primary Hyperammonemia

Hyperammonemia stemming from defects in urea cycle enzymes or transporters.

Secondary Hyperammonemia

Hyperammonemia caused by factors inhibiting the urea cycle, like substrate deficiencies or enzyme inhibition.

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Folate (Vitamin B9)

A vitamin important for one-carbon metabolism and DNA synthesis, crucial for rapid cell growth.

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Cobalamin (Vitamin B12)

A vitamin vital for one-carbon metabolism and preventing neurological damage.

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Methotrexate

A drug blocking DNA synthesis, used in cancer treatment, and sometimes needing folate supplementation.

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Glutamate/Glutamine

These amino acids are involved in transporting ammonia to the liver for urea cycle.

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Megaloblastic Anemia

A type of anemia caused by impaired DNA synthesis, leading to large, immature red blood cells.

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One-Carbon Metabolic Pathways

Metabolic pathways involving the transfer of single carbon units, such as in synthesis of amino acids and nucleotides.

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What is angiogenesis?

The process of forming new blood vessels, essential for wound healing.

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What does VEGF do?

Vascular Endothelial Growth Factor (VEGF) stimulates angiogenesis, promoting the growth of new blood vessels.

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Fibroblast Activation

The process where fibroblasts lay down fibrous tissue, forming the foundation for scar tissue.

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What is the role of TGF-β?

Transforming Growth Factor Beta (TGF-β) stimulates collagen production and reduces inflammation, helping in wound healing.

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Granulation Tissue

A type of tissue appearing 3-5 days after injury, composed of collagen and new blood vessels, forming the base for scar tissue.

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Myofibroblasts

Fibroblasts that can contract, pulling the wound edges together and contributing to scar formation.

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What is edema?

The accumulation of excess fluid in the interstitial space, causing swelling.

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What is transudate?

Protein-poor fluid accumulation caused by increased hydrostatic pressure, often occurring in non-inflammatory conditions.

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S-Adenosylmethionine (SAM)

A methyl-group donor in the synthesis of various compounds, including hormones, phospholipids, and DNA.

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Transsulfuration Pathway

Essential metabolic pathway for homocysteine metabolism; maintains homeostasis by dealing with homocysteine.

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Homocystinuria

A genetic disorder caused by defects in the transsulfuration pathway, often caused by a deficiency in CBS (Cystathionine β-synthase).

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Islets of Langerhans

Endocrine glands in the pancreas that produce hormones like insulin and glucagon.

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Insulin

A hormone that regulates blood glucose levels by promoting glucose uptake into cells.

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Glucagon

A hormone that raises blood glucose levels by stimulating glycogen breakdown in the liver.

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GLUT2

An insulin-independent glucose transporter found in the liver and pancreas.

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GLUT4

An insulin-dependent glucose transporter found in muscle and adipose tissue.

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Type 1 Diabetes

A condition where the body doesn't produce insulin, leading to high blood sugar.

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Ketoacidosis

A serious complication of diabetes where the body produces excessive ketones.

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Hyperglycemia

High blood sugar levels.

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AGEs

Advanced glycation end products; molecules formed when sugar reacts with proteins, causing inflammation.

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Pentose Phosphate Pathway

A metabolic pathway that produces NADPH and pentoses.

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NADPH

A crucial molecule for reducing the harmful effects of oxidative stress and involved in various metabolic processes.

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Polyol Pathway

Converts glucose to sorbitol and then fructose.

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G6PD Deficiency

A genetic disorder affecting an enzyme that breaks down harmful oxygen byproducts in red blood cells. The most common enzyme deficiency, it's X-linked and results in increased susceptibility to hemolytic anemia, especially under certain conditions.

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Bite Cells + Heinz Bodies

These are characteristic features seen in G6PD deficiency under a microscope. Bite cells are red blood cells with irregular, notched edges, while Heinz bodies are dense, granular deposits of denatured hemoglobin found in the red blood cells.

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Fava Bean Purine Glycoside

This chemical found in fava beans can trigger hemolytic anemia in individuals with G6PD deficiency. It triggers oxidative stress in red blood cells.

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Oxidant Drugs (AAA)

These are drugs like antibiotics, antimalarials, and antipyretics that can cause hemolysis (destruction of red blood cells) in people with G6PD deficiency.

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Favism

A rare hereditary condition characterized by hemolytic anemia triggered by eating fava beans or inhaling their pollen. It's strongly linked to G6PD deficiency.

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Neonatal Jaundice

This condition develops in newborns due to an overproduction of bilirubin, a breakdown product of heme. It can be more severe in infants with G6PD deficiency.

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Amino Acid Metabolism

The process of breaking down, building up, and utilizing amino acids within the body. It plays a crucial role in various pathways, including protein synthesis, energy production, and detoxification.

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Glycogen Synthesis

The process of creating glycogen, a storage form of glucose, from excess glucose in the body. This primarily happens in the liver and muscles.

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Glycogen Degradation

The breakdown of glycogen into glucose, which is released into the bloodstream to provide energy. This is mainly done by the liver and muscles.

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Glycogen Storage Diseases

A group of genetic disorders affecting the enzymes involved in glycogen metabolism, leading to abnormal glycogen accumulation in specific tissues.

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Marasmus

A severe form of protein-energy malnutrition characterized by extreme calorie deficiency. This leads to muscle wasting, fat emaciation, and anemia.

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Kwashiorkor

A type of protein-energy malnutrition with a protein deficiency. This leads to edema (swelling), low albumin levels in the blood, and anemia.

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Vitamin D Synthesis

The process of producing vitamin D in the skin under exposure to sunlight (UVB rays). Vitamin D is crucial for calcium absorption and bone health.

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ABO Blood Group

A blood group system based on the presence or absence of specific carbohydrate antigens (A and B) on red blood cells, with naturally occurring antibodies against non-host antigens.

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Rh Blood Group

A blood group system characterized by transmembrane proteins with over 50 antigens, with the D antigen being highly immunogenic and most important. Individuals with the D antigen are Rh positive, while those without are Rh negative.

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What is the most important Rh antigen?

The D antigen is the most important Rh antigen because it is highly immunogenic, meaning it is more likely to trigger an immune response if a person is exposed to it.

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Newborn Hemolytic Disease

A condition that can occur when a Rh-negative mother carries a Rh-positive fetus, leading to maternal antibodies attacking the fetus's red blood cells.

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Direct Antiglobulin Test (DAT)

Also known as the Coombs Test, this test detects antibodies or complement bound to red blood cells, helping identify autoimmune hemolytic anemia or incompatibility in blood transfusions.

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Packed RBCs

Red blood cells separated from plasma, used to increase oxygen-carrying capacity in patients with anemia or blood loss.

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Platelets

Small cell fragments crucial for blood clotting, important in managing bleeding disorders and platelet deficiencies.

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Fresh Frozen Plasma (FPP)

Plasma frozen within 8 hours of collection, containing clotting factors used to treat clotting disorders.

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Cryoprecipitate

A concentrated form of fibrinogen, extracted from FFP, used to manage massive bleeding.

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Acute Hemolytic Transfusion Reaction (AHTR)

A life-threatening reaction where pre-formed antibodies in the recipient's blood attack transfused red blood cells, leading to rapid lysis.

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Delayed Hemolytic Transfusion Reaction (DHTR)

A less rapid reaction compared to AHTR, caused by an immune response to a specific blood antigen, leading to extravascular hemolysis.

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Anaphylactic Transfusion Reaction

A severe, life-threatening allergic reaction caused by antibodies against plasma proteins in the donor blood, often in individuals deficient in immunoglobulin A (IgA).

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Transfusion Related Acute Lung Injury (TRALI)

A serious complication characterized by sudden hypoxemia (low blood oxygen) during transfusion, leading to lung damage.

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Transfusion Associated Circulatory Overload (TACO)

A condition caused by rapid transfusion of large volumes leading to fluid overload in the bloodstream, potentially causing heart and lung strain.

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Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

A common reaction characterized by fever, chills, and rigors, caused by cytokines present in blood products.

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Septic Transfusion Reaction

A serious complication caused by bacterial contamination of the blood product, which can cause severe infection.

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Study Notes

UICOM Block Two Study Guide

  • This study guide covers pathogenesis and microbiology for medical school preclinical curriculum.
  • It includes open access study guides for various medical topics.

Open Access Pre-Clinical Study Guides

  • Body Systems & Homeostasis (65 pages)
  • Pathogenesis & Microbiology (90 pages)
  • Musculoskeletal, Skin, Connective Tissue Study Guide (90 pages)
  • Cardiology Study Guide (69 pages)
  • Respiratory Study Guide (50 pages)
  • Renal Study Guide (39 pages)
  • Gastrointestinal Study Guide (60 pages)
  • Neurology / Psychiatry Study Guide (125 pages)
  • Endocrine Study Guide (39 pages)
  • Reproduction Study Guide (44 pages)
  • Biostatistics / Epidemiology Study Guide (10 pages)
  • Physical Exam Maneuvers Study Guide (13 pages)

Block 2 - Week 1: Fate of Amino Acids - Urea Cycle

  • Fed state: protein synthesis
  • Fasting state: protein degradation
  • Amino acids are transported to the liver to build blood proteins and convert excess nitrogen into urea.
  • Alanine/glutamate are major nitrogen carriers in the blood from muscle and kidney.
  • Aminotransferases are the first step in amino acid breakdown.
  • NH₄⁺ is toxic, so amino acids travel until converted to urea for excretion.
  • Blood ALT/AST levels measure liver injury.

Block 2 - Week 1: Glutamate/Glutamine

  • Glutamine is used to transport nitrogen to the liver to make urea.
  • Glutamine/glutamate interconversion carries NH₄⁺.

Block 2 - Week 1: Urea Cycle

  • The urea cycle converts ammonia to urea for excretion.
  • It occurs exclusively in the liver, using several enzymes (CPS I, OTC, ASS, ASL)
  • Defects in urea cycle enzymes or transporters can lead to hyperammonemia.

Block 2 - Week 1: Secondary Hyperammonemia

  • Secondary hyperammonemia: inhibited by substrate deficiencies / enzyme inhibition (e.g., fatty acid oxidation deficiency, carnitine cycle defects, etc.)

Block 2 - Week 1: One Carbon Metabolism - Folate

  • Folate is found in nuts, lentils, chickpeas, leafy greens, and fortified food.
  • Deficiency can lead to megaloblastic anemia and neural tube defects.
  • Folate aids in one-carbon transfer reactions for synthesis of purines, etc.
  • Folates are transported into epithelial cells and stored for 3-4 months in the liver.

Block 2 - Week 1: One Carbon Metabolism - Cobalamin

  • Cobalamin (Vitamin B12) is produced by bacteria and found in meat.
  • Deficiency leads to secondary folate deficiency and irreversible neurological symptoms.
  • Cobalamin is vital for methyl-group transfer to various reactions.

Block 2 - Week 1: Mono/Disaccharides and Pentose Phosphate Pathway

  • Galactose metabolism involves enzymes in many tissues (compared to liver-specific fructose metabolism)
  • Defects in fructose and galactose metabolism causes various disorders, including fructose intolerance and classic galactosemia.

Block 2 - Week 1: Pentose Phosphate Pathway

  • Pentose Phosphate Pathway (PPP) generates NADPH and ribose-5-phosphate for various cellular processes.
  • NADPH plays a role in glutathione reduction, detoxification of H₂O₂, and phagocytosis.

Block 2 - Week 1: Diabetes Pathophysiology

  • Pancreatic islets contain alpha cells (produce glucagon), beta cells (produce insulin), delta cells (produce somatostatin), and PP cells.
  • Beta cells help regulate glucose by releasing insulin.
  • Glucagon, epinephrine, increase blood glucose.

Block 2 - Week 1: Type 1 vs Type 2 Diabetes

  • Key differences between Type 1 and Type 2 Diabetes.
  • Pathophysiology of hyperglycemia, with a strong emphasis on advanced glycation end products (AGEs) interactions, protein kinase C activation, oxidative stress.
  • Key differences concerning glucose regulation.

Block 2 - Week 1-2: Gram-Positive Bacteria

  • Covers Gram positive bacteria, including Staphylococcus (aureus, epidermidis, saprophyticus), Streptococci (pyogenes), and various anaerobic, aerobic bacilli
  • Specific features are summarized, including cell wall structure, hemolysis and antibiotic resistance etc.
  • A key focus is on infections and toxins.

Additional: Block 2 - Week 2, 3, and 4

  • Other chapters and topics are not summarized.

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