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Alya Cards Pathology Robbins basis > Ch 9 > Flashcards

Ch 9 Flashcards

1
Q

What diseases are caused by greenhouse gases and climate change? 4

A
  1. Cardiovascular/Cerebrovascular/Respi - heatwaves and air pollution
  2. Gastroenteritis - cholera due to water pollution
    3.vector borne infections eg malaria increased weather temp
    4.Malnutrition - reduced crop production
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2
Q

What is a Xenobiotic?

A

Exogenous chemicals in environment - air, water, food and soil which can become toxic or non toxic compounds

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3
Q

The most important catalyst of phase I reactions are (group of enzymes)

A

Cytochrome p450

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4
Q

What does the cytochrome P450 do?

A

Catalysed reactions that detoxify xenobiotics or convert them to active compounds that cause cell injury

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5
Q

What is smog?

A

Smoke and fog

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6
Q

What are examples of outdoor air pollutants?

A

Ozone
Lead
CO
Sulfur dioxide

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7
Q

What is the affinity of CO to Hb?

A

200x

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8
Q

What happens to CO in the environment?

A

Becomes oxidised to CO2

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9
Q

How does CO poisoning cause death?

A

CNS depression –> coma

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10
Q

Where are ischemic changes seen in the brain of CO poisoning?

A

Basal ganglia
Lenticular nuclei

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11
Q

What is the classic sign of acute CO poisoning in a fair skinned person?

A

Cherry Red skin and mucous membranes (high levels of carboxy haemoglobin)

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12
Q

What test is used to diagnose CO poisoning?

A

Blood levels of carboxyhb

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13
Q

The no 1 cause of lung cancer in non smokers is from (pollutant)

A

Radon

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14
Q

—-(pollutant) can cause legionnaires disease and viral pneumonias

A

Bioaerosols (from pet dander, dust mites)

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15
Q

Formaldehyde is considered a (term)

A

Carcinogen

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16
Q

How does lead cause disease?

A

Binds to sulfhydryl groups on proteins and interferes with calcium metabolism —> skeletal, neurological, GI, renal toxicity

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17
Q

Where is most of lead stores in the body (children)

A

Children: teeth and bones (80-85%). The rest in blood

The rest in blood (5-10%) and soft tissues

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18
Q

What effects are associated with lead level of 10ug/ml? 4

A

low IQ, hearing impairments/growth impairments/peripheral nerve function impairment

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19
Q

What effects are associated with lead level of 40 ug/ml? 1

A

Decreased Hb synthesis

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20
Q

What level of lead is associated with death?

A

150 ug/ml

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21
Q

What symptoms are associated with lead level of 100ug/ml? 4

A

Frank anemia
Nephropathy
Encephalopathy
Colic

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22
Q

How does lead interfere with haemoglobin synthesis?

A

Inhibits Delta aminovulimic dehydratase and ferrochelatase (haem synthesis)

Inhibits Na-K dependant ATPases in membranes (increases fragility of RBCs)

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23
Q

What is diagnostic findings of lead poisoning?

A

Elevated Lead levels plus either

Elevated RBC free protophyrin levels
Or elevated zinc protophyrin levels

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24
Q

What kind of anemia is seen in lead poisoning?

A

Microcytic

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25
Q

Anemia and basophilic stippling is classically associated with (disease)

A

Lead poisoning

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26
Q
A

Radiodense lead lines: lead poisoning

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27
Q
A

Radiodense lead lines: lead poisoning

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28
Q

What are the neurological effects of lead poisoning: children vs adults?

A

Children: Brain damage
Adult: peripheral demyelinating neuropathy

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29
Q

Lead exposure can lead to which renal problems? 2

A

Interstitial fibrosis
Decreased uric acid excretion eg saturnine gout

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30
Q

What are the types of mercury? 3

A
  1. Organic (methyl mercury)
  2. Inorganic (mercuric chloride)
  3. Metallic (elemental mercury)
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31
Q

What are the main sources of mercury? 2

A

Contaminated fish (methyl mercury)
Dental amalgrams/workers (metallic)

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32
Q

How does mercury cause it’s effects?

A

Similar to lead

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33
Q

Where are skin cancers caused by arsenic exposure usually found?

A

Palms and soles

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34
Q

What kinda of cancer is arsenic known to give rise to? 3

A

Skin
Lung
Bladder

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35
Q

What are the effects associated with arsenic exposure? 4

A
  1. Neurologic: sensorimotor neuropathy
  2. CVD: HTN and prolonged QT interval
    3.skin changes: hyperpigmentation/hyperkeratosis
  3. Cancers
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36
Q

What are the most toxic forms of arsenic? 3

A

Arsenic trioxide
Sodium arsenite
Arsenic trichloride

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37
Q

How does arsenic cause it’s effects (mechanism)

A

Inhibits oxidative phosphorylation in mitochondria (trivalent arsenic replaces P in ATP)

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38
Q

What is nicotine? How does it work?

A

Alkaloid substance found in tobacco leaves

Binds to nicotinic acetyl choline receptors in brain to release catecholamines–> increase HR, BP, cardiac contractility

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39
Q

Smoking: Which components are involved in development of lung cancer? 2

A

Polycyclic hydrocarbons
Nitrosamines

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40
Q

What are the fetal risks of maternal smoking?

A

Spontaneous abortion
Preterm birth
Intrauterine growth retardation

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41
Q

What are the 3 enzymes that metabolize ethanol?

A

Catalase
Cytochrome P450
Alcohol dehydrogenase

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42
Q

A blood alcohol concentration of 80mh/dL is reached after how many SD drinks?

A

3

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43
Q

Where is alcohol dehydrogenase located?

A

Cytosol of hepatocytes

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44
Q

Which cytochrome P450 isotype metabolizes ethanol?

A

CYP2E1

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45
Q

What does acetaldehyde metabolize into?

A

Acetate/acitic acid

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46
Q

Why is fat accumulated in liver of alcoholics?

A

Alcohol dehydrogenase causes NAD reduction (increase in NADH)

NAD is needed for FA oxidisation in liver and to convert Lactate to pyruvate

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47
Q

What is the main nutritional deficiency in alcoholics?

A

Thiamine B1

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48
Q

People who have ALDH2*2 mutation and drink are at risk of which cancer?

A

Esphageal cancer

49
Q

What is the mechanism of acetaminophen metabolism?

A

95% goes through Phase II enzymes –> glucoronate/sulfate congugates–>urine excretion

5% goe through CYP2E1–> NAPQI –> lipid peroxidation and protein adducts –>liver necrosis

GSH can detoxify NAPQI

50
Q

What is the treatment of acetaminophen poisoning and it’s mechanism?

A

N-acetylcystiene

Increases GSH levels to metabolize NaPQI

51
Q

What necrosis is seen in liver associated with acetemenophen poisoning?

A

Centrilobular necrosis

52
Q

Excessive use of oil of wintergreen causes what poisoning?

A

Salicylate

53
Q

What is the clinical manifestations of acute salicylate poisoning (aspirin)?

A

Alkalosis (stim of resp centre in medulla)
Development of metabolic acidosis (lactate and pyruvate)
Nausea
Coma
Tinnitus
Headaches
Convulsions

54
Q

Gastric bleeding and petevhial haemorrhages are associated with which poisoning?

A

Aspirin/salicylate

55
Q

Which form of cocaine is more potent?

A

Crack (crystal form)

56
Q

What is the mechanism of cocaine?

A

Prevents reuptake of dopamine in brain (euphoria)
Prevents uptake of epinephrine and norepinephrine and stimulate NA from presynapses

57
Q

What are the symptoms of cocaine use?

A
  1. Cardiac: arrhythmias (Na/Ca/K disruption), coronary vasospasm, dilated carfiomyopathy
  2. CNS: seizures and dilated pupils (most common)
  3. Perforation of nasal septum (snorters)
    4.high temp
  4. High BP
58
Q

What are the effects of cocaine in pregnancy?

A

Decrease blood flow to placenta –> fetal hypoxia and spontaneous abortion

Neurological impairment

59
Q

What is the mechanism that aspirin causes bleeding?

A

Thromboxane A2 inhibition

60
Q

What is the classic presentation of endocarditis in IV heroin users?

A

Right sides tricuspid (S. Aureus)

61
Q

Which drug causes feeling of euphoria and then a ‘crash’?

A

Methamphetamine

62
Q

What is the mechanism of methamphetamines?

A

Releases dopamine in the CNS –>inhibition of presynaptic neurotransmission at corticostriatal synapses–>slowed glutamate release

63
Q

Long term use of this drug causes confusion, pyschosis and paranoia?

A

Methamphetamine

64
Q

Which illicit drug causes inability to judge time/speed/distance?

65
Q

What is the most common opportunistic infection in burns?

A

Pseudomonas aeruginosa

66
Q

Classification of burns relies on (burn characteristic)

A

Depth of burn

67
Q

Burn tissue is what type of necrosis?

A

Coagulative

68
Q

What are heat cramps?

A

Excessive electrolyte loss from sweating etc leads to cramping of voluntary muscles

69
Q

What is heat exhaustion?

A

Brief collapse due to failure of CV system to compensate for hypovolemia. Recovers with hydration

70
Q

What is heat stroke?

A

Thermoregulatory mechanisms fail, core temp 40: rapid vasodilation and hyperkalemia, arrhythmia and sustained muscle contraction

Can lead rhabdo/muscle necrosis

71
Q

Why does heat stroke lead to rhabdo?

A

Disruption of ryanodine receptor (RYR1): excessive calcium leakage from SR: muscle contraction stimulated

72
Q

What kind of arrhythmia is associated with electrical injury?

A

Ventricular arrythmia

73
Q

What is a dangerous characteristic of alternating currents(electricity) in homes?

A

With contact, can cause tetanic muscle spasms, which would prolong exposure to current and cause chest wall spasm and asphyxia

74
Q

What are the two types of radiation?

A

Ionising
Non ionising

75
Q

What is ionising radiation?

A

Radiation that can displace electrons from the atom

76
Q

What is the definition of ionisation?

A

Collision of electrons with other molecules released electrons in a reaction cascade

77
Q

What is the definition of Curie (Ci) radiation unit?

A

Disintegration per second of radioisotope (amount radiation from a source)

78
Q

What is a Gray (Gy) or Rad?

A

Amount of radiation absorbed by target tissue per unit mass

79
Q

What is Sievert unit (Sv) in radiation?

A

Equivalent dose

80
Q

What is the Field size concept in radiation?

A

Smaller area exposed to large amounts of radiation is tolerable.

However bigger areas exposed to small doses of radiation can be fatal

81
Q

Which tissues are more vulnerable to ionising radiation?

A

Rapidly dividing cells eg gonads, bone marrow, lymphoid tissue, mucosa, GI tract

82
Q

How does ionising radiation cause cell death?

A

DNA damage get detected by P53: this then leads to cell cycle arrest and apoptosis of DNA damage is too great

83
Q

What is the mechanism of which radiation causes DNA damage?

A

ROS radiolysis of water

84
Q

What is primary malnutrition?

A

Missing from diet

85
Q

What is secondary malnutrition?

A

There is a cause eg GI issues, increased needs, impaired use/storage

86
Q

What is severe acute malnutrition?

A

Weight for height ratio that is 3 SD below normal range

87
Q

How does Marasmus develop?

A

Low calories (catabolic muscles, head too large for body)

88
Q

What is the serum albumin of a child with Marasmus?

A

Normal or slightly low (as visceral protein stores not badly affected)

89
Q

What immunity is affected in Marasmus?

A

T cell mediated

90
Q

What is the clinical features of kwashiorkor?

A

Oedema
Weight 60-80% normal (fluid retention)
Muscle mass is spared
Skin/hair hypopigmented ‘flaky paint’

91
Q

What causes kwashiorkor?

A

Low protein relative to calories, hypoalbuminemia

92
Q

What size is the liver of kwashiorkor child?

A

Enlarged - fatty

93
Q

Why do kwashiorkor child may not respond to milk based diets initially?

A

Disachiridase deficiency - mucosal atrophy and loss of villi. Decrease mitotic cells in crypts of glands

94
Q

Thymic atrophy is seen more is (nutritional disease)

A

Kwashiorkor

95
Q

This is seen in bone marrow. DX?

A

Anorexia nervosa (increased fat deposition in bone marrow)

96
Q

What is the diagnostic finding in blood for anorexia nervosa 3

A

Low levels of GnRH, LH, FSH

97
Q

How does Leptin regulate appetite?

A

Leptin binds to receptors in hypothalamus –> stimulation of POMC/CART and inhibit NPY/AgRP

This inhibits appetite

98
Q

Aflatoxin increases risk of which cancer?

A

Hepatocellular carcinoma

99
Q

What cancers are associated with obesity for both genders? Men? Women?

A

Both: oesophagus and kidney
Men: colon, thyroid
Women: endometrium, gallbladder

100
Q

How does obesity promote cancer?

A
  1. Too much insulin (IGF-1 is carcinogenic)
  2. Steroid hormones: regulates cell growth and diff in tissues
  3. Reduced adiponectin secretion: no suppression to proliferation
101
Q

Which component in the retina is sensitive to light (needed for night vision)

A

Rhodopsin rods

102
Q

What can oxygen toxicity cause to lungs?

A

Diffuse pulmonary infiltrates

103
Q

What deficiency is pellagra caused by?

104
Q

What deficiency do alcoholics have?

105
Q

Symptoms of thiamine deficiency?

A

Neuropathy
Cardiomyopathy
Wernickes

106
Q

What cancer is at higher risk of developing in women that use oral contraceptives?

A

Hepatic adenoma

107
Q

What are the 3Ds of pellagra?

A

Diarrhea
Dermatitis
Dementia

108
Q

Which drug can mimic acute psychosis?

A

Phencyclidine (PCP)

109
Q

Illicit drug that causes acute pulmonary oedema?

110
Q

What kind of rays cause thermal injury?

A

Infrared rays

111
Q

Where is ethylene glycol found? What disease

A

Anti freeze
Renal tubular necrosis

112
Q

What is the effect of methanol?

A

Blindness
CNS depression
Acidosis

113
Q

How does methanol cause blindness?

A

Toxic metabolites: formaldehyde and acetaldehyde damage the retina

114
Q

What deficiency is seen in Beri Beri

115
Q

Symptoms of Beri beri 2

A

Cardiac failure
Peripheral oedema

116
Q

What symptom is seen in zinc deficiency?

A

Haemorrhagic dermatitis

117
Q

Isoniazid can cause which deficiency?

A

Pyridoxine(B6) - pyridoxine antagonist

118
Q

Atrophic gastritis mainly causes which deficiency?

119
Q

Effects of heroin?

A

Respiratory depression
Convulsions
Cardiac murmurs (endocarditis)

Alya Cards Pathology Robbins basis (12 decks)

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