Chapter 9 Flashcards
How does 1,25(OH2)D stimulate mineralization of the bone
Stimulates osteoblasts to synthesize calcium binding protein osteocalcin, which stimulates calcium deposition
What are the nuclear receptors associated with CYP induction
- acyl hydrocarbon receptor
- peroxisome proliferator-activated receptor (PPAR)
- two orphan nuclear receptors
- constitutive androstane receptor (CAR)
- pregnant X receptor (PXR)
How does 1,25(OH2)D Increased intestinal absorption
Calcium absorption in the duodenum via binding with RXR complex and increased transcription of TRPV6, which is a calcium transporter
What are the non-vitamin D effects of 1,25(OH2)D
-Immunomodulator and anti proliferative effects
What do renal disorders cause with regards to vitamin D
-Decreased synthesis of 1,25(OH2)D, phosphate depletion (no reabsorbance), malabsorption disorders
Which vitamin deficiency is commonly producing overgrowth of cartilage or osteoid tissues at the costochondral joints, known as rachitic rosary
Vitamin D
What is the chemical commonly found in inhaled vapor drugs
Toluene
Most of the alcohol in the blood is converted into what and in what location
Acetylaldehyde in the liver
What is the affect of RBC levels following high doses of radiation
Anemia appears 2-3 weeks later (half life 120 days), and persists for months.
How does 1,25(OH2) stimulate breakdown of bone in hypocalcemic and high PTH levels
Activates expression of RANKL on osteoblasts, which bind to osteoclasts, releasing phosphate and calcium from bone (via HCL and cathepsin K)
How do sustained muscle contractions occur in heat stroke victims
- nitrosylation of RYR1 receptors
- Impairs RYR1 receptors allowing calcium to leak out
- Causes muscle contractions
What is smoking associated with with regards to CV
Atherosclerosis and subsequent MIs
What is the process of metabolization of the small fraction of acetaminophen
- CYP2E metabolizes to NAPQI (N-acetyl-p-benzoquinoneimine)
- NAPQ interests with glutathione, which detoxifies it
What are the three cell types affected by marrow aplasia
Granulocyte, platelets, RBCs
What are the most common acute affects on CNS with cocaine use
-hyperpyrexia and seizures
With the increases in temperature, what is the result in CV diseases
Worse due to heat wave and air pollution
What is the relation of vitamin C to vitamin E
Vitamin C may have antioxidant activity to regenerate vitamin E
Where are the general effects of arsenic poisoning seen
Heart, GI, nervous system, skin
How is the level of phosphate excretion in the kidney affected
Bone fibroblast growth factor 23 (FGF23), which is a phosphatonin, which blocks the uptake of phosphate in the intestine and kidneys
What are the chemical properties of most solvents and drugs
Lipophilic
What is malignant hyperthermia
Inherited mutations in RYR1 cause post anesthetic administration to cause a heat stroke like rise in core body temperature
What compartment is primarily affected in Kwshiorkor
Visceral compartment since protein deprivation is more than total calories
What is microcytic hypochondriac anemia and what causes it
Lead causes the decrease in heme production and subsequent hemoglobin
In the NPY pathway, what is released from the primary neurons onto the secondary neurons
NPY onto T 1/5 receptors
What is the skin affect of use of the antibiotic minocycline
Discoloration of the skin
With the increases in temperature, what is the result in GI, cholera, and water born illnesses
Increases as flood and heavy rains contaminate the clean water
What is a diagnostic feature of anorexia
Amenorrhea (caused by decreased levels of LH and FSH)
What are the common causes of death in burn victims
-Pneumonia, septic shock with renal failure or acute respiratory distress
How does nicotine work
Binds to nicotinic acetylcholine receptors in the brain, causes the release of catecholamines from the SNS, resulting in the increase in HR, BP and CO
Radon gas damage is due to which two decay particulates
Polonium 214 and 218
What is the amino acid change in defect alcohol dehydrogenase
Normal ALDH1 —> inactive ALDH2 (lysine for glutamate at codon 487)
What is the risk of miners to develop lung cancer as composed to those not exposed to mining chemicals
10 fold increase
What is the presentation of acute vitamin A toxicity
Headache, vomiting, stupor, blurred vision, may be confused with symptoms of pseudotumor cerebral
Alcohol dehydrogenase breaks down alcohol in which compartment
Cytosol
What is the main target of damage with radiation in the range of 2-10 Sv and what is the main sign
Bone marrow, showing hair loss, vomiting, hemorrhage, leukopenia in 2-6 weeks
What is the condition of chloracne characterized by
Acne, cyst formation, hyperpigmentation, hyperkeratosis generally around the ears and face
What is the risk of anabolic steroids and hormones
-Inhibits production and release of LH and FSH via feedback, as well as increase the amount of estrogens due to the metabolites of steroids
What is inhibited by PYY
NPY pathway
What is the result of CYP metabolism of carbon tetrachloride
Toxic trichloromethyl free medical
What is the mechanism of adiponectin action
Binds to AdipoR1 and 2
Activated PKA
Inactivates acetyl CoA carboxylase (required for FA synthesis)
What are the clinical presentations of someone using anabolic steroids
- Stunted growth in adolescence
- Acne, gynocomastia, testicular atrophy in males
- Facial hear and menstrual changes in females
- Hepatic cholestasis (in oral administration)
How can vitamin K be synthesized endogenously
Intestinal microflora
What hormones related to eating are produced in the ileum and colon
Peptide YY (PYY)
With the increases in temperature, what is the result in vector borne infectious diseases
Such as coccy, which is increasing as droughts in CA occur
What are first order neurons from the hypothalamus and what is their general result
1) CART/POMC (increases energy expenditure)
2) NPY/AgRP (increases food intake)
What are the two products during cachexia and what is their effect
- Proteolysis inducing factor (excreted in urging in weight losing patients)
- Lipid mobilizing factor (increased FA oxidation and proinflammatory cytokines)
—> both lead to NFkB and degredation of skeletal muscles and their myosin heavy chains
Why is lead poisoning more common in children than adults
Children absorb about 50% of ingested lead, while adults only about 15%. In addition, passes through the BBB more readily
When is a child said to have marasmus
Weight falls to 60% of normal for sex, age, and height
What are the clinical presentations of Minamata disease
Cerebral palsy, deafness, blindness, mental retardation, CNS defects in utero
Vitamin D toxicity will present as what
Metastatic calcifications of soft tissue such as kidneys, bone pain and hypercalcemia
Vitamin D deficiency in rickets and osteomalacia result in what underlying condition
Excess of unmineralized matrix
What are the blood level of marasmus patients
- normal albumin levels
- low leptin levels
- High cortisol (fat burning)
- vitamin deficiency
- T cell deficiency
What is the risk of oral contraceptives and cervical cancers
Increased risk with those with HPV
What is the mechanism to counter act acetaminophen overdoes
N-acetylcysteine to replace the GSH levels
Inhalation of mineral dust can lead to which kind of cancer
Lung, aka pneumoconioses
What is the most active form of vitamin D and where is it converted
1,25(OH)2D in the kidney
What are the general clinical presentations of aspirin overdose
-headaches, dizziness, tinnitus (ringing of ears), hearing impairment, confusion, drowsiness, vomiting, diarrhea, gastric issues
Superficial burns contain which layer
Epidermis
What are the common signs seen in patients with secondary PEM
- Depletion of subQ fat in arms, chest, shoulder, or metacarpals
- Wasting of quads or deltoids
- Ankle or sacral edema
Acute alcoholism leads to which effects
- hepatic and gastric changes (fatty or hepatic changes)
- gastritis and ulceration
- depressant, first in the subcortical regions
How is vitamin D transported in the blood to the liver
Plasma alpha1 globulin (aka D binding protein or DBP)
Immediately following hypocalcemia in which calcium levels return to normal, what are the levels of phosphate
Remain low due to phosphatonins, which prevent mineralizaion of bone
What is aplastic anemia
Very high doses of radiation kill the marrow stem cells and induce permanent drops in levels
How does cancer due to arsenic present
Multiple and appear on the palms and soles, and non-malignant respiratory disease
What is the result of lead on hemoglobin synthesis and what levels are increased in the body
Suppresses synthesis via the enzymes that place iron into protoporphyrin, therefore there will be elevated levels of protoporphyrin in the blood
What size particles of soot are the most damaging
Ultra fine particles less than 10 micrometers in diameter, which are engulfed by macros and induce inflammation. Greater than this size are trapped in mucous of airways
What are the blood levels in kwashiorkor
Hypoalbuminia
- Increased fluid retention (edema)
- Immune cell deficiencies
How do flat bones form
Intramembranous bone formation (mesenchymal cells differentiate into osteoblasts
What is primary malnutrition
Missing the major components in the diet
50% of all deaths in children younger than 5 are attributed to which 3 conditions
- pneumonia
- diarrheal disease
- malaria
What is a major mechanism that DNA is damaged by ionizing radiation
Radiolysis of water generates ROS that damage tissues and cells
How does 1,25(OH2)D stimulate calcium absorption in the kidney
Increased calcium influx via increased expression of TRPV5
What are the clinical presentations of heat stroke
- vasodilation with peripheral pooling of blood.
- Hyperkalemia, tachycardia, arrhythmias
- Sustained contraction of skeletal muscles
What part of the tumor is less sensitive to radiation damage
The center hypoxic portion due to the lack of oxygenation
What are the commonly seen kidney issues with opiate users
- amyloidosis (secondary to infections)
- focal and segmental glomerulosclerosis (induces nephrotic syndrome and proteinuria)
What is the direct product of alcohol oxidation and what is the clinical presentation
Acetylaldehyde and results in the acute affects of alcohol, as well as the increased risk of oral cancers
What is the result of haploinsufficency of brain derived neurotrophic factor (BDNF) in MC4R pathway
Associated with obesity in WAGR patients (Wilms tumor)
BPA exposure results in what
Endocrine disrupter, heart disease
What are the principal lesions as a result of thiamine deficiency in alcoholics
-peripheral neuropathies, Wernicke-Korsakoff syndrome, cerebral atrophy, cerebellar degeneration, optic neuropathy
Chronic alcoholism is associated with increases in which cancers due to acetylaldehyde
-Esophageal and laryngeal cancer (especially those with ALDH*2)
Full thickness burns contains which layer
Subcutaneous tissue, with sometimes including the muscle underneath
How does cadmium get uptaken into the cells
Via ZIP8, which is a zinc transporter
Which enzymes are inhibited by lead
- aminolevulinic acid dehydratase
- ferrochelatase
What is the mechanism of action for arsenic poisoning
Interferes with mito oxphos, as trivalent arsenic replaces the phosphates in ATP
What do symptoms do dioxins and PCBs cause
Folliculitis and dermatosis known as chloracne
What is the effect of combination progesterone-estrogen therapy on cancers in women
-Increased risk of breast cancer after 5 to 6 years
What is a major complication of anorexia
Cardiac arrhythmias and sudden death as a result of hypokalemia
How can niacin be synthesized endogenously
Tryptophan
What does retinol bind to and where is it synthesized
Binds to retinol binding protein (RBP), which is synthesized in the liver
What is a common consequence of radiation in the field
Fibrosis as a result of dead paranchymal cells be replaced by connective tissue
What are the direct effects of injury as a result of hypothermia
Physical disruption within cells by high salt concentrations due to the crystallization of intra and extracellular water
What is the risk of oral contraceptives and thromboembolism
3 to 6 times increase due to elevated production of coagulation factors
What are the three main mechanisms that 1,25(OH2)D production is regulated
1-hypocalcemia stimulates PTH release, which stimulates conversion in kidney
2-Hypophosphatemia activates alpha1-OHase
3-Increased 1,25(OH2)D stops PTH activation of alpha1-OHase
How is lead able to cause damage
Binds to sulfhydryl groups in proteins and interferes with calcium metabolism and subsequent inhibition of NT release
What is the single leading global cause of health loss
Undernutrition (1/3 of Disease burden)
How do neuro defects present in arsenic poisoning
2 to 8 weeks later consisting of sensorimotor neuropathy causing paresthesis, numbness and pain
What is mortality of cachexia usually due to
Atrophy of the diaphragm and respiratory muscles
What is the affect of vitamin A on metabolism
9-cis-retinoic acid binds to PPAR (peroxisome proliferator-activated receptors) which are key regulators for the oxidation of fat tissues and muscles
What is pickwickian syndrome and what is it associated with
Obesity leads to Hypoventilation, hypersomnolence (sleep apnea, polycythemia, right sided heart failure)
What are the 5 infectious agents leading from top 10 causes of death
- respiratory infections
- HIV/AIDs
- diarrheal diseases
- TB
- Malaria
What condition can readily resemble a pseudotumor cerebri
Vitamin A toxicity
What is the risk of oral contraceptives and breast carcinomas
No increase
What occurs within hours of high doses of radiation
Severe hymphopenia, shrinkage of LN and spleen. Returns to normal writhing weeks to months
What are the clinical presentations of marasmus
Growth retardation, loss of uncle, depletion of peripheral compartment, emancipated extremities, head to large for body, immune deficiency
Due to tobacco smoke, what organ is affected by the carcinogen N-nitrosonornicicotin (NNN)
Esophagus
What are the CV effects of alcoholism
- Myocardium dialated congestive cardiomyopathy (aka alcohol cardiomyopathy)
- hypertension
- decreased HDL production
- acute and chronic pancreatitis
What is the general mechanisms and location of damage in cadmium poisoning
Toxic to the kidneys and lungs through production of ROS
What is the relationship between the blood alcohol levels with the breath
They are proportional
What is the risk of oral contraceptives and hepatic adenoma
Increased risk of this rare benign tumor, which is well encapsulated mass
What is marrow aplasia and what are the blood levels of neutrophils following high doses of radiation
Radiation affects the bone marrow and the cells there. Causes slight increase in neutrophils, followed by neutropenia (have half life of 1 day). Reaches zero around week 2. Recovery take 2-3 months
Which psychiatric disorder has the highest death rate
Anorexia
What is the product formed from carbon monoxide and Hb
Carboxyhemoglobin
The microsome oxidation system uses what to convert alcohol into acetylaldehyde
-CYP2E1 in the SER
What is released from POMC first order neurons onto the secondary neurons
MSH onto the melanocorticin receptors 3 and 4
How can Vitamin D be synthesized endogenously
Precursor steroids
What is the mechanism that benzene is toxic
It is oxidized by hepatic CYP2E1, which forms a toxic metabolism. This results in disruption of differentiation of hematopoietic cells in bone marrow, leading to aplasia and leukemias
What are heat cramps and what is the body core temp
Loss of electrolytes due to sweating, and maintained at normal
What are the greatest threats to a burn patient
Shock, sepsis, and respiratory insufficiency
What is the mechanism of ozone toxicity
Production of free radicals, which injury epithelial cells along the respiratory tract, Type 1 alveoli, and inflammation
What are the clinical presentations of acetaminophen overdose
Nausea, vomiting, diarrhea, shock, followed by days of jaundice
Due to tobacco smoke, what organ is affected by the carcinogen polycyclic aromatic hydrocarbons, NNK, NNN
Oral cavity
What conditions will decrease the activity of CYP
Starving or fasting conditions
What is a natural source of acetylsalicylic acid
Methyl salicylate contained in ointments that contain wintergreen
How can the amount of second hand smoke be measured
The amount of cotinine, which is a metabolite of nicotine
What is the risk of oral contraceptives and endometrial and ovarian cancers
Protective/decreased risk
What is the result of lead in the blood in children
-deficits in intellectual capacity, hyperactivity (ADHD), poor organizational skills
What are the most commonly inhaled substances leading to pneumoconioses
Coal dust, silica, asbestos, beryllium
What hormones related to eating are produced in the stomach
Ghrelin
What is the most common form of hyperthermic syndrome
Heat exhaustion
What form of mercury is most letha to developing brains and what is the mechanism
Methyl mercury, due to its lipid solubility and accumulation in the brain
Rubber workers and their exposure are at increased risk of what
Leukemia, particularly acute myeloid leukemia
What is the substrate and product converted in the kidney and what is the enzyme
25(OH)D to 1,25(OH)2D Via 1alpha(OHase)
What is secondary malnutrition
Resulting from the malabsorption, impaired storage or utilization, excess loss or increased need for nutrients
What is the hyperbolic state associated with burns
Excess heat loss results in an overactive metabolic state to replace the lost heat, where BMR can double
What is acetylaldehyde converted into and by which enzyme
Converted into acetate by Acetylaldehyde in the mitochondria
What is the main target of damage with radiation in the range of 0-1 sv, and what are the main symptoms
None
What are the examples of organochlorides
Synthetic lipophilic products that resist degredation such as
DDT,lindane,aldrin, dieldren, PCBs and dioxin
What is the mechanism of action of acetaminophen overdoes
Unconjugated NAPQI builds up in the liver due to the limited amount of glutathione available, leading to damage (centilobular necrosis)
1) covalent binding to hepatic proteins causing cellular and mito damage
2) Depletion of GSH leads to inability to neutralize ROS
What are common blood level findings in patients with anorexia
- Decreased LH and FSH
- Decreaed bone density
- Decreased thyroid hormone
What are the clinical presentations of lead poisoning
- lead lines, as hyperpigmentation of gums
- increased bone epiphysis density in kids
- inhibition of bone fracture healing
- suppression of heme synthesis, anaemia
- Demylanation of of nerves
- Chronic tubulointerstital disease in kidneys
What does hypocalcemia incur during vitamin D deficiency
PTH is elevated leading to:
1) Renal alpha-1 OHase activation (increased vit D and calcium
2) resorption of bone by osteoclasts
3) Decreased renal excretion of calcium
4) Increased excretion of phosphate
What are the clinical presentations of a patient exposed to high levels of organosolvents such as benzene, butadiene, chloroform, and carbon tetrachloride
Dizziness, confusion, CNS depression, coma
What is a major diagnostic complication of aspirin poisoning
Acute erosive gastritis leading to intestinal bleeding and ulceration
What is the main target of damage with radiation in the range of 1-2 Sv and the main sign
Lymphocytes producing lymphopenia/granulocytopenia in 1 day to 1 week
How do long bones form
Endochondral ossification, where cartilage is formed, then replaced by bone
Where are CYP450s primarily located
ER of the liver
What is the relationship between aflatoxin and cancer
Causes mutation in codon 249 in TP53, leading to hepatocellular carcinomas
How does Vitamin A help regulate genes
- retinoic acid receptors (RARs) activated and bind to RXR.
- Complex binds to regions controlling gene expression and tumor suppressors
Obese patients have high levels of circulation what
CRP
Metabolism of alcohol causes what down stream effects
- CYP2E1 releases ROS leading to lipid peroxidation of hepatocytes
- Released of LPS from gram neg
- TNF from LPS release
IN what ways does smoking increase the risk of CVs and MI
-Increase in platelet aggregation, Decreased myocardial oxygen supply, increased oxygen demand, and increased chance of Vfib
Rubber workers are exposed to which agents
Organosolvents such as benzene and 1,3-butadiene
In patients with osteomalasia, where are the likely locations of microfractures
Vertebral bodies and femoral neck
What are the forms that cadmium poisoning will take
- Obstructive lung disease due to necrosis of alveolar epithelial cells
- renal tube damage that can progress to end stage renal disease
What group of patient is commonly seen to have kwashiorkor
African children who have been weaned too early and are fed a carb diet
What can cause vitamin A toxicity
-Polar bear liver, whale, sharks or tuna livers
Due to tobacco smoke, what organ is affected by the carcinogen 4-aminobiphenyl, 2 naphthlamine
Bladder
What occurs with blood vessels during radiation
Usually will see dilation, then shrinking of the lumen as it is filled with fibrosis due to healing, as well as thickening of the lamina
What does catalase breakdown of ethanol occur
In peroxisomes
What is required for the absorbance of vitamin A
-Bile, pancreatic enzymes, antioxidant activity in food
What is the most dangerous damage to DNA
Double stranded breaks
Which compartment is affected by marasmus and why
Peripheral and somatic compartment with subQ fats and proteins being used as fuel
Bioaerosols are able to cause infectious diseases such as
Legionnaires disease, viral pneumonia, common cold
What is the mechanism of action for dabigatran and when is it commonly used
Direct inhibitor of thrombin, and given to patients with atrial fibrillation to prevent thromboembolism
What are the major effects of vitamin A deficiency
- Night blindness
- epithelial changes to metaplasia
- xerophthalmia (conjunctiva being replaced with keratin)
- Bitot spots (build up of keratin debris following dry eyes)
- keratomalacia (erosion of corneal surface following dry eyes)
- Immune deficiencies
What is the main protective mechanism against mercury poisoning
Intracellular glutathione, which acts as a sulfhydryl donor
What is the earliest manifestation of vitamin A deficiency
Night blindness
What are the common complication so bulemia
1) electrolyte imbalance (hypokalemia)
2) pulmonary aspiration of gastric juice
3) esophageal and gastric rupture
What is released from the secondary neurons in the NPY pathway
MCH ad orexin
Acetaminophen is metabolized by which enzyme and what is the excreted molecules
95% is Metabolized by phase 2 enzymes and excreted in urine as glucoronate or sulfate conjugates
What is the most common infection of opiate users, and what are the other commonly seen ones
-Viral hepatitis (most common)
-10% had endocarditis, especially right sided heart valves (tricuspid) causes by S. Aereus
-
Prader Willi syndrome is marked by which chromosome deletion and subsequent deletion of which eating hormone
15q11-q13 with decreased levels of PYY leading to obesity
What are the changes seen in adult CNS during lead poisoning
Peripheral demyelination neuropathy, which involves the motor end units of the most commonly used muscles. In particular the extensor muscles of wrist and fingers, followed by the perineal muscles
What are the presentation fo chronic vitamin A toxicity
Weight loss, anorexia, nausea, vomiting, and bone/joint pain
Where is most absorbed lead stored and for how long
Stored in teeth and bones, usual with a half life of 20-30 years
What is the stimulated and inhibited with leptin
Stimulates CART pathway
Inhibits NPY pathway
What occurs during phase 1 reactions to metabolize metabolites
Undergo hydrolysis, oxidation or reduction
How does vitamin A deficiency cause follicular or popular dermatosis
-Hyperplasia and hyperkeratinization of epidermis cause plugging of the ducts if the adnexal glands
PEM preferentially affects who the most
Aka protein energetic malnutrition aka malnutrition affect Children
What hormones released to eating are produced in the fat cells
Leptin and adiponetin
What is the effect of platelet levels following high does of radiation
Thrombocytopenia appears by the end of the first week (10 day half life)
What is a heat stroke
Assoacited with high temp, humidity, and exertion. The body temp can reach as high as 40degrees C.
Where are organosolvents such as chloroform and carbon tetrachloride found
Degreasing and dry cleaning agents, as well as paint removers
What are the most toxic forms of arsenic
-arsenic trioxide, sodium arsenite, arsenic trichloride
What is the process of CYP induction
- Inducers bind to nuclear receptors
- Dimerize with retinoic X receptor (RXR) to associate with promoter
- increased CYP
What are the physical morphologies seen in rickets
- Softened occipital bones become flattened, and parietal bones may buckle inward, and elastic recoil back into place with release of pressure (craniotabes)
- Frontal bossing and squared appearance of the head
- pigeon chest
- lumbar lordosis and bowing of the legs
What are conditions that can cause Kwashiokor
Protein losing enteropathies, nephrotic syndrome, extensive burns, fad diets,
What are the three enzymes in the lover that are responsible for conversion of alcohol to acetylaldehyde
- alcohol dehydrogenase
- ethanol oxidizing system
- catalase
What is the most common source of exposure of cadmium
Food
Which derivative of vitamin A has the highest affinity for RARs
Al trans-retinoic acid
What are the effects of obesity on hormone levels
INcreased estrogen via aromatase
Increased androgens in ovaries and adrenals
Inhibits sex hormone binding globulin (SHBG) in liver
Where is the majority of required vitamin D synthesized and what percentage
90% in the skin
What is the result of adiponectin
Fatty acid oxidation and decreased fat mass “fatt burning molecule” and “guardian against obesity”
Exposure to vinyl chloride results in which condition
Angiosarcoma
Through which enzyme do macrophages have the ability to produce 1,25(OH2)D
CYP27B
What is substrate and product of the liver in vitamin D metabolism and what is the exnzyme
Vitamin D to 25(OH)D via 25OHase (aka CYP27A1)
Alcoholism leads to which vitamin deficiency
Thiamine (B1) deficiency
What are the skin changes associated with arsenic poisoning
Hyperpigmentation and hyperkeratosis
What are the results of increased insulin levels
Retention of sodium, expansion of blood volume, excess Norepinephrine, smooth muscle proliferation
What are conditions that can lead to vitamin A deficiency in otherwise healthy individuals
-Use of laxatives, malabsorption syndromes such as celiac disease and crohns, and colitis
What is the mechanism of warfarin, and what is the issue with using it
It is a vitamin K antagonist, but can be interfered by vitamin K rise foods
How can Vitamin D deficiency diets be supplemented
Fish oils
How does lead poisoning lead to gout
Renal failure with decreased uric acid excretions can lead to “saturnine gout”
How many NADH are produced from a molecule of ethanol
2 NADH
How do the immunomodulary and antiproliferative effects occur mechanistically
1,25(OH2)D binds to the membrane bound VitD receptor, mVDR, which citrates PKC and opens calcium channels
Alcohol and cirrhosis lead to increases in which cancers
Hepatocellular carcinoma
What is stimulates by ghrelin
NPY pathway
In patients with Kwashiorkor, what is the change seen in the bowel
-decrease glandular crypts resulting in loss of villi. Results in disaccharidase deficiency. So infants do not respond well to milk based diets
What are the major consequences of using anticoagulants
Bleeding disorders, but also emboli stroke and other thrombin complications
What is heat exhaustion and what causes it
Failure of CV to compensate for hypovolemia caused by dehydration. Results in fainting and collapse and can be reversed with rehydration
What population is MHT used in and what is the reasoning
Only in postmenopausal women because of the increased risk of uterine cancer
What occurs during phase 2 of metabolism of xenobiotics
Phase 1 products are metabolized into water soluble compounds via glucuronidase, sulfation, methylation, conjugation with glutathione
What is the risk of oral contraceptives and CV
Doubles the coronary disease risk in women who smoke and are older than 35
Alcoholism leads to what conditions in the GI tract
Bleeding from ulcer, esophagus, and gastritis
What is the only hormone with oregenic effects
Aka Increased food uptake by ghrelin
What is the effect of MHT on risk of DVT and strokes
Thrombosis is more pronounced in individuals with hypercoagulative states such as factor 5 or Prothrombin mutations
-Increased risk in first 2 years
What is the effect of acuter salicylate overdose
- alkalosis via stimulation of the respiratory center in medulla
- followed by metabolic acidosis due to buildup of lactate and pyruvate as a result of uncoupling of oxphos and inhibition of Krebs
- Nonionized Forms of salicylate go to brain to cause nausea and coma
What are the clinical presentation of kwashiorkor
-Edema, skin lesions with alternating hyper-pigmentation zones (areas of desquamation), and hypopigmentation (area of flaky paint), loss of hair color or alternating pale and color hair, fatty liver (decreased synthesis of carrier proteins for lipoproteins)
Partial thickness burn contains which layer
Dermis
Where is vitamin C commonly seen in modern world
- Patients undergoing peritoneal dialysis and hemodialysis
- infants on formulas of evaporative milk without Vit C supplementation
What is the effect of organochlorines
Disruption of hormonal balance because of antiestrogen or antiandrogen activity
How does vitamin A toxicity lead to bone fractures
Retinoic acid will stimulate osteoclast formation, leading to bone resorption
What are xenobiotics
Exogenous chemicals in the environmental air, water, food, and soil that are absorbed into the body through ingestion, inhalation, and skin contact.
What are the changes seen in the blood and bone marrow as a result of lead poisoning
- Ring sideroblasts, which are red cel precursors with iron laden macrophages in the bone marrow
- in the blood, punctuate basopilic stippling of the red cells
What is analgesic nephropathy
Mixture of aspirin, phenoacitin, acetaminophen when taken over many years canes cause tubulointerstital nephritis with papillary necrosis
What percentage does cachexia occur in cancer patients and which particular cancers
50%, especially GI, pancreatic and lung cancers
How does mercury cause damage to the body
Binds to sulfhydryl groups in proteins with high affinity, leading to CNS and kidney damage
What vitamin deficiencies are seen in women who have frequent pregnancies followed by lactation
Vitamin D
What is the major source of vitamin D for humans and what does it required
7-dehydrocholesterol and requires UVB (290-315)
What is the most common DNA repair mechanism andwhat is the effect
NHEJ, which can lead to deletions and mutations
What is the main target of damage with radiation in the range of 10-20Sv
Small bowel, showing diarrhea, fever, vomiting, electrolyte imbalance in 5-14 days
Vitamin C can lead to which cause of death
Hemorrhages, commonly seen in scurvy
How is vitamin A packaged, uptaken and stored
Packaged in chylomicrons, uptaken by the liver via Apolipoprotin E, then store in perisinusoidal stellate (Ito) cells
What are the pulmonary injuries associated with opiate use
Edema, septic embolism from endocarditis, lung abscess, infections, foreign body granulomas, often highlighting talc in the spleen levied, lungs and LNs
What are the blood levels of gonadotropin in bulemia patients
Normal due to normal weight (results in 50% no having amenorrhea)
Due to tobacco smoke, what organ is affected by the carcinogen polycyclic aromatic hydrocarbons, NNK, and polonium 210
Lung and larynx
When are the effects of hypothermia and hypoxia on limbs finally seen
When they return to normal temperature
Due to tobacco smoke, what organ is affected by the carcinogen NNK
Pancreas
In the POMC pathway, what are the products released from the secondary order neurons
TSH and CRH
With regards to eating, what processes and integrates the information
Arcuate nucleus of the hypothalamus
What is the most serious consequence of chronic arsenic exposure
Development of cancers, especially skin, lungs and bladder
What skeletal abnormalities are associated with cadmium poisoning
Calcium loss that can be associated with osteoporosis and osteamalacia known as Itai-Itai
