9.2 Environmental & Nutritional Disorders Flashcards
What is the leading exogenous cause of human cancer with the cause of 90% of lung cancers?
Tobacco
Cessation of smoking decreases mortality and risk of death from cardiovascular disease within 5 years, and decreaseases lung cancer mortality by what percent within 5 years?
A. 11%
B. 21%
C. 31%
D. 51%
21%
Though lung cancer mortality decreases by 21% within 5 years of stopping smoking, there is still excess risk that lasts for up to how many years?
A. 10 years
B. 20 years
C. 30 years
D. 40 years
30 years
How does smoking lead to the development of emphysema?
A. Recruitment of leukocytes to the lung
B. Increase in elastase production
C. Both A and B
D. None of the above
Both A and B
Leukocytes trigger increase in elastase production that leads to lung injury that characterizes emphysema
Which of the following statements are true?
A. CYPs facilitate the excretion of carcinogens in cigarrete smoke
B. Electrophilic intermediates of cigarette smoke form DNA adducts that covalently modify oncogenes
C. Electrophilic intermediates of cigarette smoke form DNA adducts that covalently modify tumor supressor genes
D. All the above are correct
E. None are correct
All the above are correct
Just be sure to read and undestand these
What 2 substances have a multiplicative affect on increased risk and incidence of development of laryngeal and oral cancers?
A. Tobacco and Alcohol
B. Alcohol and Marijuana
C. Cocaine and Alcohol
D. Tobacco and Marijuana
Tobacco and Alcohol
Cigarrette smoking is associated with cancers of what 6 organs and/or structures?
Kidney
Cervix
Pancreas
Esophagus
Bladder
Bone Marrow
KC PEBBm smokes
What are the 3 most common diseases caused by cigarrette smoking that involve the lungs?
What 2 cardiovascular issues is smoking also implicated in?
Emphysema
Chronic Bornchitis
COPD
athersclerosis
MI
A couple has just discovered they are pregnant, and have set up an appointment to learn about good practices in preparation for birth. You learn both the mother and father are current smokers. With this information, which of the following is likely to occur to their infant if they do not stop smoking?
A. Decreased risk for spontaneous abortion
B. Increased risk of rapid fetal growth and preterm delivery
C. Delayed growth of the fetus that can result in their child being delivered at a low-birth weight
D. All of the above
C. Delayed growth of the fetus that can result in their child being delivered at a low-birth weight
Intrauterine Growth Retardation (IUGR)
At what blood alcohol level is drunk driving able to be declared?
Drowsiness?
Stupor?
Coma with respiratory arrest?
At what blood alcohol level is drunk driving able to be declared?
80 mg/dL
Drowsiness?
200 mg/dL
Stupor?
300 mg/dL
Coma with respiratory arrest?
>300 mg/dL
Which of the following processes is the main route through which alcohol is converted to acetaldehyde in the liver?
A. Aldehyde dehydrogenase in the mitochondira
B. CYP2E1 in the endoplasmic reticulum
C. Catalase in the peroxisome
D. Alcohol dehydrogenase in the cytoplasm
D. Alcohol dehydrogenase in the cytoplasm
Which of the enzymes is directly involved in the mechanism that contributes to increase in lactic acid levels and steatosis seen with excessive alcohol intake? Bonus: explain
A. Aldehyde dehydrogenase in the mitochondira
B. CYP2E1 in the endoplasmic reticulum
C. Catalase in the peroxisome
D. Alcohol dehydrogenase in the cytoplasm
E. A and D
A and D
A. Aldehyde dehydrogenase in the mitochondira
D. Alcohol dehydrogenase in the cytoplasm
Both of these processes reduce NAD+ to NADH, and low levels of NAD+ lead to increase lactic acid build up and steatosis (fatty liver). NAD is need for fatty acid breakdown
Acute alcoholism causes each of the following, but is mostly implicated in what effect?
A. CNS depressant
B. Hepatic steatosis
C. Acute gastritis
D. Ulceration
A. CNS depressant
NOTE: the effects A-D are all reversible with acute
What is the main site of injury in chronic alcoholism?
Liver
Which of the following is cirrhosis of the liver associated with?
A. Alcoholic hepatitis
B. Increase risk of hepatocellular carcinoma
C. Portal Hypertension
D. A and C
E. B and C
F. All of the above
B and C
B. Increase risk of hepatocellular carcinoma
C. Portal Hypertension
Chronic alcoholism is associated with alcoholic cardiomyopathy due to decreased levels of what substance that occurs when the liver is damaged? Note, decreased levels of this substance is associateed with increased liklihood of coronary artery disease.
A. VLDL
B. IDL
C. LDL
D. HDL
HDL
Chronic alcoholism within the 1st trimester of pregnancy is the most harmful, and can lead to what syndrome?
What morpholgies are seen in the newborn? (3)
How is the child affected as it grows up?
Fetal Alcohol syndrome
Microcephaly, growth retardation, and facial anomalies
Decreased mental functions
Chronic alcoholism leads to an increased incidence in what 4 types of cancer?
Oral cancer
Esophageal cancer
Liver cancer
Breast cancer
Chronic Alcoholism causes cancer that BLOEs
The picture below depicts foci of hemmorrhage and necrosis in the mamillary bodies and 3rd and 4th ventricle walls. This occurs in what syndrome?
Is this portion of the syndrome reversible, and if so how can you treat it?
What develops if this syndrome is left unrecognized and untreated?
WErnicke’s Encephalopathy as part of Wernicke’s Korsakoff syndrome
Wernicke’s is reversible and can be treated with Thiamine (vit B1)
Korsakoff (it’s irreversible brother)
Korsakoff develops when Wernicke’s is left unrecognized and untreated. It is characterized by symptoms of truncal ataxia, unsteady gait, and nystagmus. What histological changes are you most likely to see in the brain of someone with Korsakoff syndrome?
A. Swelling and increased differentiation of granule cells in the cerebrum
B. Atrophy and loss of granule cells in the anterior vermis of the cerebellum
C. Atrophy and loss of granule cells in the posterior-inferior vermis of the cerebellum
D. Swelling and increased differentiation of granule cells in the posterior-inferior vermis of the cerebellum
B. Atrophy and loss of granule cells in the anterior vermis of the cerebellum
Which of the following is true of oral contraceptives?
A. Increases risk of breast cancer and development of coronary artery disease in women >30 years old
B. Increases risk of breat cancer development by 2x’s in smokers over 35 years old
C. Trigger development of hepatic adenomas which are very prevelant and often malignant
D. HPV+ women have a 3-6x greater risk of developing a venous thrombosis
E. Decrease risk of cervical cancer
D. HPV+ women have a 3-6x greater risk of developing a venous thrombosis
Acetaminophen poisoning has the greatest toxic effects on what organ?
Liver
- Centrilobular Necrosis*
- NOTE: Acetominophen OD takes up GSH stores, but if treated early with GSH the PT can be fine*
What type of posoning is associated with poisoning effects on the brain leading to nausea and eventual coma?
A. Acute salicylate poisoning (aspirin)
B. Chronic salicylate poisoning (aspirin)
A. Acute salicylate poisoning (aspirin)
What type of posoning is associated with Head Aches, dizziness, tinnitus, bleeding, and coma?
A. Acute salicylate poisoning (aspirin)
B. Chronic salicylate poisoning (aspirin)
B. Chronic salicylate poisoning (aspirin)
Salicylates aka aspirin has the most toxic effects on what organ?
Kidney
Analgesic nephropathy
Intravenous use of opiates tends to cause infections in all of the following locations, EXCEPT?
A. SubQ
B. Endocarditis of left heart valve
C. Liver
D. Lungs
B. Endocarditis of left heart valve
should be RIGHT heart valve
Indicate which layers are impacted in each of the burn classification levels.
1st Degree Burn:
2nd Degree Burn:
3rd degree burn:
1st Degree Burn:
epidermis
2nd Degree Burn:
epidermis and dermis (partial thickness burn)
3rd degree burn:
all the way to subQ (full thickness burn)
Which of the following burns would you need to get set up to treat pulmonary edema and shock?
A. Right arm front/back
B. Right and left arm front/back
C. Right leg front/back
D. Front of torso and head
- A. Right arm front/back= 9%*
- B. Right and left arm front/back=18%*
- C. Right leg front/back= 18%*
D. Front of torso and head = 22.5%
With burns we often see infection and sepsis due to the colonization of what 3 common pathogens?
MRSA
Pseudomonas aeuginosa
Candida
What is the difference between hyperthermia and malignant hyperthermia?
Hyperthermia is just heat stroke caused by exposure to temperatures our body can’t compensate for
Malignant hyperthermia is a reaction to anesthetics due to mutant RYR1 gene, where we see heat-stroke like symptoms of elevated core temp as well as muscle contraction
In ionizing radiation morphologically we see what type of changes in the cells, which is similar looking to cancer cells?
Nuclear swelling
Giant cells
Pleomorphic nuclei (variable size and shape)
What changes might we see in irradiated vessels?
A. Endothelial cell proliferation
B. Collagenous hyalinization
C. Thickening of the Intima
D. Obliterated or very thin lumen
E. All of the above
All of the above
COTE
Look at this image of major morpholigc consequences of radiation injury
Look at this too
T/F: The brain needs the highest [] of radiation to be injured, but the least amount of time of exposure to see changes compaired to other organs
True
NOTE: there is variability in acute radiation effects between organs in terms of [] and timing
How does marasmus develop?
What happens to the albumin levels?
Is subQ spared?
not enough calories
normal albumin levels
subQ gets used up
How does kwashiorkor develop?
What happens to the albumin levels?
Is subQ spared?
not enough protein
decrease in serum albumin levels
subQ is spared, but we do see edema and fatty liver
Cachexia is a PEM complication that is seen in people with AIDs or advanced cancer. It is characterized by extreme weightloss, muscle atrophy, anemia, anorexia, and edema. Death is usually due to atrophy of what structures?
Atrophy of diaphragm and other respiratory muscles
EXplain the mechanism that occurs in Cachexia that leads to muscle atrophy.
TNF from the host cells and PIF from tumor cells bind to receptors that trigger the release of NFkB. NFkB enters the nucleus and binds to DNA and induces production of muscle specific ubiquitin ligases. These ligases signal the proteosomes to destroy the myofibrils they bind to.
Which of the following are complications of both bulemia and anorexia?
A. Decrease in thyroid hormone and decreased bone density
B. Esophageal and gastric rupture
C. Pulmonary aspiration of gastric contents
D. Cardiac arrhythmia and sudden death due to hypokalemia
D. Cardiac arrhythmia and sudden death due to hypokalemia
Read and understand this
This too
What 4 substances are said to have anti-carcinogenic effects due to antioxidant properties?
Vitamin C
Vitamin E
beta-carotenes
Selenium
CE-selenium Beta
Which of the following normally is incorporated into NAD and NAD phosphate and normally involved in redox reactions, BUT deficiency leads to Pellagra (three Ds)? Bonus: What are the 3 Ds of Pellegra?
A. Vitamin K
B. Vitamin B1 (thiamine)
C. Vitamin B3 (niacin)
D. Vitamine B6 (pyridoxine)
Vitamin B3 (niacin)
Dementia, Dermatitis, and Diarrhea
Cheilosis, glossitis, dermatitis, peripheral neuropathy, and failed myelinization maintenance are all results of a deficiency in which of the following vitamins?
A. Vitamin K
B. Vitamin B1 (thiamine)
C. Vitamin B3 (niacin)
D. Vitamine B6 (pyridoxine)
D. Vitamine B6 (pyridoxine)
A child is brought in by their parents, because they are worried that their child has started to “bump into things more”. The childs history shows that they’ve often been brought in for recurrent infection to measels. You recognize that the child is likely suffering to a deficiency in Vitamin A. Which of the following findings would also help support your diagnosis?
A. White, foamy area of keratinising squamous metaplasia seeen in the bulbar conjunctiva
B. Hypocalcemic tetany seen in distal appendages
C. Frontal bossing, squared head, pigeon breast deformity, and bowing of the legs
D. Bleeding diathesis
A. White, foamy area of keratinising squamous metaplasia seeen in the bulbar conjunctiva
NOTE: These are Bitot spots
Hypochromic microcytic anemia is associated with deficiency in which of the following substances?
A. Vitamin K
B. Iron
C. Vitamin D
D. Vitamin B3 (niacin)
B. Iron
Which of the following is secreted from the intenstines and works to inhibit the NPY/AgRP pathway which normally signals to increase food intake? (what signal comes from the intestines to decreases food intake)
A. Leptin
B. PYY
C. Ghrelin
D. Insulin
B. PYY
Which of the following alterations are most likely to be seen in the metabolic syndrome that arises from obesity?
A. Visceral or intra-abdominal adiposity
B. Insulin resistance with hyperinsulinemia
C. Glucose intolerance
D. HTN, hypertriglyceridemia, and decreased HDL
E. All of the above
F. Some of the above
G. Some of the above if Mercury is in retrograde
E. All of the above
NOTE: Hyperinsulinemia is associated with increase in IGF-1, a mitogen that can contribute to cancer development
Which of the following can lead to an increase in cell proliferation and decrease in apoptosis?
A. Increase in IGF-1
B. Decrease in IGF-1
C. Increase in SHBG production
D. None of the above
A. Increase in IGF-1
Exposure to which of the following is most likely to contribute to development of hepatocellular carcinoma?
A. High animal fat and low fiber diet
B. Nitrosamines and Nitosamides
C. Aflatoxin
D. Vitamin C, Vitamin E, B-carotenes, and selenium
C. Aflatoxin
Exposure to which of the following is most likely to contribute to development of gastric carcinomas?
A. High animal fat and low fiber diet
B. Nitrosamines and Nitosamides
C. Aflatoxin
D. Vitamin C, Vitamin E, B-carotenes, and selenium
Nitrosamines and Nitrosamides
Exposure to which of the following is most likely to contribute to development of colon cancer?
A. High animal fat and low fiber diet
B. Nitrosamines and Nitosamides
C. Aflatoxin
D. Vitamin C, Vitamin E, B-carotenes, and selenium
High animal fat and low fiber diet
Which of the following correctly illustrates the most vulnerable to least vulnerable cells in the CNS with hypoxic exposure?
A. Neurons> Oligodendrocytes> AStrocytes > Endothelium
A. Neurons> Oligodendrocytes> AStrocytes > Endothelium
NOAE People with brain cells say NO American Eagle
Blood and marrow changes occur fairly rapidly and are characteristic of lead exposure. Specifically the inhibition of ferrochelatase by lead results in which of the following?
A. Ring sideroblasts
B. Microcytic (<80fL), HYPERchromic anemia
C. Microcytic (<80 fL), HYPOchromic anemia
D. A and B
E. A and C
A and C
Ring sideroblasts
Microcytic (<80 fL), HYPOchromic anemia
NOTE: we can also see puncate basophilic stippling of the red cells
Because of the bodies inclination to rapidly waste excess _______, we are least likely to see acute toxic buildup of this vitamin.
A. Vitamin A
B. Vitamin B1 (thiamine)
C. Vitamin C
D. Vitamin D
C. Vitamin C
T/F: In people who develop asbestosis, we can often see Ferruginous bodies which are asbestos fibers coated in iron within cells of those affected
True
T/F: NAD is required for FA-oxidation in the liver AND for conversion of lactate into pyruvate
True
Which of the following is considered to be the main agent associated with alcohol-induced laryngeal and esophageal cancer?
A. Acetate
B. Acetaldehyde
C. THiamine B1
D. Stop making things up
B. Acetaldehyde
NOTE:
Acetaldehyde-DNA adducts have been detected in some tumors from these tissues
People with ALDH2*2 allele who drink are at a higher risk for developing esophageal cancer
T/F: People with Korsakoff syndrome have been known to be “honestly lying” due to short-term memory defects
T/F: Bone marrow and blood cells are affected in almost 50% of all drug related deaths
True
True
Deposition of drug metabolite, iron, and melanin pigment in dermis cells (as depicted below) are associated with adverse reactions to which of the following drugs?
A. Minocycline
B. Acetominophin
C. Aspirin
D. Warfarin
Minocycline
Tubulointerstitial nephritis with renal papillary necrosis is known as analegsic nephropathy that is seen in which of the following over exposures?
A. Minocycline
B. Acetominophin
C. Aspirin
D. Warfarin
Aspirin (chronic)
Lethal arrhythmias seen in cocaine use are caused by which of the following mechanisms?
A. Increase of NADH/NAD ratio
B. Disruption of normal ion (K, Ca, Na) transport to the myocardium
C. Excessive platelet aggregation leading to a thrombolytic event
D. All of the above
B. Disruption of normal ion (K, Ca, Na) transport to the myocardium
Match the following with the definitions below:
Curie (Ci), Gray (Gy), Sievert (Sv)
- Representation of the amount of radiation emitted by a source as radiation emitted/second:
- Amount of energy absorbed by tissues:
- The equivalent dose that corresponds to the biologic effect:
- Representation of the amount of radiation emitted by a source as radiation emitted/second: Curie (Ci)
- Amount of energy absorbed by tissues: Gray (Gy)
- The equivalent dose that corresponds to the biologic effect: Sievert (Sv)
Litty
