Chapter 9 Flashcards
Which form of radiation is associated with the following types of cancer?
AML
CML
Thyroid papillary carcinoma
Ionizing radiation
What type of radiation is related to UV light and microwaves?
Non-ionizing radiation
Which form of radiation is associated with the following types of cancer?
Basal Cell Carcinoma of the Skin
Squamous Cell Carcinoma of the Skin
Melanoma of the Skin
Non-ionizing
__________ radiation results in the formation of double-stranded breaks in DNA and ________ which damage DNA
Ionizing ; ROS
Deep partial thickness burns involve which layers of the skin?
- Epidermis,
2. Dermis
Describe a 3rd degree burn?
white charred, NO PAIN, due to nerve damage
Patients who have been hit by lightning will present with a characteristic _________skin finding
litchenburg figures
Serious burns can lead to what type of shock?
HYPOVOLEMIC
\- burns damage capillaries in the skin, leading to a significant increase in capillary permeability (allowing massive fluid efflux which is lost to environment since interstitium is exposed)
- Treated with IV fluids, life-threatening if not promptly dealt with
Which degree burn causes blistering of skin?
2nd degree
_______ are injuries to tissue caused by heat, chemicals, and/or radiation
BURNS
Types include:
chemical (acid/alkali), electrical
radiation (UV/medical), thermal (fire)
What 3 things are likely to colonize on person with burned skin?
- Pseudomonas aeruginosa
- Candida,
- MRSA
Pregnant Mother rushes into the ER and it is found that the placenta has prematurely separated from the uterine wall prior to delivering her baby. Which of the following could apply to this situation?
- malnutrition
- cocaine abuse
- recent tobacco cessation
- mother has history of hypotension
Answer : COCAINE
cocaine use during pregnancy can result in spontaneous abortion
________ intoxication can cause agitation, hypertension and pupillary
Cocaine
What drug intoxication presents as pupillary dilation, euphoria, hypertension, and paranoia that lasts for multiple hours?
Amphetamines (ecx. METH)
differs from cocaine because cocaine is SHORTER DURATION
What is the most lethal complication of cocaine intoxication?
Sudden cardiac death
-can occur with FIRST time users too! YIKES
Pt is undergoing chemotherapy and experiences alot of nausea. What can you prescribe to alleviate the symptoms?
Marijuana
-has antiemetic effects
What drug intoxication presents as conjunctival injection, increased appetite, paranoid delusions, and dry mouth?
Marijuana
-also may present with euphoria,
anxiety,
perception of slowed time, impaired judgment,
hallucinations
In the united states, the majority of overdose deaths are caused by _____
- opiods
- MDMA
- LSD
- bath salts
- OPiods
A 34-year-old white male presented with dyspnea, fatigue, and dry cough. Urine drug screen for benzodiazepine, narcotics, methamphetamines was unremarkable. Chest imaging showed pulmonary talcosis. Which of the following does the patient have?
- side effect of allergy medication
- user of oxycodone
- has a genetic predispostition
- works around silica
- heroin user
- when prompted this pt would admit to injecting oxycodone
TALCOSIS:
Often seen in heroin users where the heroin has been cut with talc OR injection of drugs intended for oral administration (ex benzos), regardless of route (inhalation or injection) talc causes pulmonary effects
Pt comes into urgent care with erythematous rash present diffusely throughout the upper torso. Patient denies recent travel , exposure to chemicals or new lotions. What is at the top of you differential?
Drug - induced hypersensitvity
MOST commonly presents as SKIN RASH
What 3 structures in the brain can be damaged as a result of Wenicke Korsakoff syndrom?
- cerebellar atrophy (anterior vermis)
- necrosis of mamillary bodies
- necrosis of 3rd and 4th ventricles
___________is characterized by a triad of opthalmoplegia, ataxia and confusion
Wernicke Korsakoff
-other symptoms include nystagmus, confabulation, personality change, and permanent memory loss
___________is a late manifestion of Wernicke encephalopathy characterized by confabulations,irreversible memory loss, and personality changes
KORSAKOFF syndrome
What are key characteristics of fetal alcohol syndrome?
microcephaly, small palpebral fissures, flat midface Low nasal bridge among other defects
Which vitamin is deficient in alcholism?
Vitamin B1 (THIAMINE)
First step in ethanol metabolism?
Ethanol may be converted to {acetaldehyde} via the enzyme alcohol dehydrogenase
With excessive alcohol consumption you build up NADH as you convert ethanol. What 2 things occur due to increased NADH (alcoholic oxidation)?
- increased lactic acidosis
2. fatty liver (b/c NAD is required for fatty acid oxidation)
Which enzyme has the SMALLEST contribution to ethanol metabolism?
Catalase
ADH and ALDH are the biggest contributors
Many Asians are deficient of the ethanol metabolism b/c of deficiency of________
Acetaldehyde dehydrogenase
Why should patients avoid alcohol consumption with any certain medications?
alcohol induces. CYP2E1 and delays other drug metabolism that requires the CYP
Which of the following function in a microsome?
- Cyp2E1
- Catalase
- ADH
- ALDH
- CYP2E1
Catalse : peroxisome
ADH: cytosol
ALDH: mitochondria
Exposure to Radon increases someones risk for ?
Lung cancer!
inhaled radon tend to deposit in the lungs
-URANIUM miners are increased risk
-
Pt presents with injury to small bowel. Symptoms of diarrhea , fever and vomtiing. What amount of total body ionizing radiation would cause these symptoms?
A. 1-0 Sv
B. 50 Sv
C. 10-20 Sv
D. 1-2 Sv
C. 10-20 Sv is related to small bowel injury
Telangiectasia is a histological finding for ?
CHRONIC radiation exposure
- in biopsy of skin you would seee
DERMATITIS
DERMAL FIBROSIS
and TELANGIECTASIA (web like veins)
An 8 y/o boy present with malnutrition and weight loss of about 80%. Which of the following would NOT be seen in this patient?
A. generalized edema
B. decreased fat stores
C. increased albumin
D. reduced arm circumference
C. decreased protein
ALL others are assoicuated with malnutrition
A patient recently underwent about 1 year of chemotherapy. They present with fatigue , weight loss over time and muscle atrophy. This patient is most likely to die from?
This patient exhibits CACHEXIA
Mortality would be caused by ATROPHY of diaphragm oR other respiratory muscles
A child is brought to you with an infection of a wound. In addition the child has chronic diarrhea nd flaky skin.
- What is a potential differential for this pt? \
- What additional symptoms would this kid have?
a. broomstick extremities
b. skin rash
c. muscle wasting
d. pitting edema
e. loss of subcutaneous fat
- Kwashiorkor
- D.
this condition present with HYPOalbuminemia which would result in edema
What type of PEM affects bedridden patients the most?
Secondary PEM ;
Enteric bacteria (Gut flora) produce vitamins, particularly Vitamins _____ and ______
K and Biotin
Calcium oxalate kidney stones may result from vitamin ____ abuse
Vitamin C
Toxicity :
calcium oxalate kidney stones and
iron toxicity
Regarding Vitamin A metabolism, how is it taken into the liver and where is it stored?
- via Apoprotein B
2. stored in ITO cells in liver
5 year old boy came to the hospital with his mother with complaints of diarrhea, skin redness, rashes and roughness of the skin associated with
some mental disorientation. This condition is due to the deficiency in ?
Niacin
(three Ds) dementia,dermatitis diarrhea
60-year-old woman with rheumatoid arthritis presents to her doctor with a 2-month history of fatigue and memory fading. She also reports feeling “wobbly” lately. Blood smear shows hypersegmented neutrophils. Which of the following could be a cause of her symptoms?
A.Vitamin A deficiency
B. Vitamin D toxicity
C. Vitamin B12 deficiency
D.Niacin deficiency
C. B12
B12 deficiency associated with memory issues and is a cause of megaloblastic anemia which was hinted by the hypersegmented neutrophils
Wobbly because B12 deficiency causes degeneration of spinal cord tracts.
Which virus can benefit from Vitamin A supplementation?
Measles in children
pg 437
Explain why people with Vitamin C deficiency experience poor wound healing?
Vitamin C activates PROLYL and LYSL hydroxylase which are important for hydroxylation of procollagen
You have a patient that presents with celiac disease. Which of the following may be true finding in this patient?
A. bone/ joint pain B. iron toxicity C. psudotumor cerebri D. decrease bone density E. nephrolithiasis
D. Decrease bone density because person with CELIAC will cause malabsorption of Vitamins ADEK. The only answer that indicates a deficiency is D.
ALL other answers are causes of EXCESS Vitamins
List some clinical features of RIckets?
frontal bossing squared head lumbar lordosis bowing of legs pigeon chest
An older pt receiving peritoneal dialysis is most likely to have a deficiency of ?
Vitamin C
Relating to obesity hyperinsulinemia causes an increase of what mitogen?
IGF -1
its receptor is highly expressed on cancer cells
Which of the following is not a result of hyperinsulinemia in obesity?
- decrease in SHBG
- increase estrogens
- decreases adiponectin
- increase IGF-1
- increases apoptosis
- hyperinsulinemia increases cell proliferation NOT apoptosis
ALl the others are correct results of hyperinsulinemia
Detection of mutant TP53 in hepatocellular carcinoma indicates?
Aflatoxin exposure
Pt has history of BMI 31. He consumes a diet rich in excessive food preservatives. What is he at risk for ?
A. gastric carcinoma
B. hepatocellular carcinoma
C. Colon cancer
D. testicular cancer
A. Gastric carinoma
Food preservatives are the source of nitrites. these are implicated in gastric cancers
Which vitamins/ trace elements are linked to anticarcinogenic effects?
Vitamin A, C, E, selenium
What would you advise an obese patient with a high fat diet to take (along with excercise), that would add a protective effect?
FIBERRRR (PROTECTS MUCOSA)
DECREASES RISK OF COLON CANCER
- increases stool bulk which decreases exposure of mucosa to offenders
- decreases capacity of fibers to bind carcinogens
Pg 449
LO 43
A 25-year-old woman is brought to the emergency room by her boyfriend after being found unconscious in her car in the garage while it was turned on. Her pulse oximetry is normal. Upon evaluation she regains consciousness and reports a slight headache. Which of the following do you NOT apply to this patients condition?
A. livor mortis B. increase Hb-O2 C. increased lactic acid D. treatment with hyperbaric oxygen E. hemorrhages in the pallidum
B. you would have decreased Hb-O2 because Hb bind CO with 200 fold affinity
All other symptoms / treeatments/ clinical presentation are associated with CO poisoning
What would cause someone to exhibit anthracosis?
anthracosis: accumulation of carbon in the lungs
So indoor or outdoor pollutants
Pb exposure causes _________ in kids and ________ in adults.
Brain damage; peripheral neuropathies
___________ leads to inhibition of the enzymes δ-aminolevulinic acid dehydratase and ferrochelatase (heme synthesis)
Lead poisoning
Symptoms of LEAD poisoning:
L: ead lines
E: nceophalopathy / E rtyhrocyte basophilic stippling
A: bdominal colic/ sideroblastic Anemia
D: rops (wrist/ foot)
What pathologic RBC finding is seen in a peripheral smear with lead poisoning?
Ringer sideroblasts seen in bone barrow
A 2-year-old girl is teething and chewing on objects found in the home. The parents say that for the past few days, daughter is lethargic and pale. She has been clutching her abdomen in pain and refusing to eat. Laboratory testing reveals an (+) prussian blue staining of RBCs. MCV of 65 and MCH of 21. Which of the folllowing would also be a symptom of her present condition?
- hematuria
- livor mortis
- lower IQ
- decreased wound healing
- wrist drop
- Lower IQ because this is a 2y/o with lead poisoning
Prussian blue stain is used to detect RINGED sideroblasts, and the lab values indicate microcytic hyppchromic anemia
NOT 5 because wrist drop would be a symptoms of adults affect by lead poisoning
SKin cancer of palms and soles is a clinical consequence of which environmental pollutant?
Arsenic
Dental fillings (amalgam) and fish is a source for ________
mercury
Herbicides, soil, water . wood preserves , metal smelting are sources of +___________
arsenic
Food, batteries, plastic, mining are sources of _________
Cadmium
Vinyl Chloride is a carcinogen associated with what type of cancer?
Angiosarcoma of liver
Silica exposure is associated with _______carcinoma
Lung
Chloracne is a hallmark of ________ toxicity
DIoxin
also causes liver and CNS damage
Golden brown rods with dumbbell appearance and fibrosis in the lungs is associated with what type of workers?
- construction
- shipyard workers
- plumbers
for ABESTOSIS
What carcinogen is associated with Mesothelioma?
Abestos
Which occupational agent has antiestrogenic and antiandrogenic properties?
Organochlorines (DDT, pesticides)
Which occupational agent is implicated with Scrotal cancer?
Polycylic carbons (combustion of fossil fuels)
What components of Tobacco have carcinogenic effects?
- tar
- polycylic aromatic hydrocarbons**
- benzopyrene
- Nitrosamine***
NICOTINE IS NOT carcinogenic
Combining smoking and what (3) other things results in a multiplicative effect?
- smoking + HTN
- SMoking + abestos workers
- Smoking + alcohol
Smoking and ALCOHOL have a multiplicative increase risk of ?
Laryngeal cancer
A 27 y/o woman presents to the ER for worsening RUQ abdominal pain. She states that her symptoms have slowly progressed since yesterday. On physical exam, you note an athletic female with well-developed muscles. Her current medications include only oral contraceptives and she is generally healthy. What should the next step be to treat this patient?
A. obtain blood culture
B. send for a liver scan
C. administer acetaminophen
D. perform ultrasound of lower extremity
B. Send for liver scan. Because she is on OCP use it is likely that she developed BENIGN hepatic adenoma.
Which of the following is true regarding thermal injury?
a. full thickness burns are extrememly painful and pain meds should be used
b. skin with superficial partial thickness burns have blisters and weeping surfaces
c. infection/ sepsis is secondary to C. diptheriae
B.
C. secondary infection due to MRSA, pseudomonas aeruginosa, Candida
A. full thickness burns : NO PAIN
What should be of primary concern if patient comes in with B/l legs and right arm burn?
This amounts to >20 % of body surface area and one should be concerned for PULMONARY EDEMA
What are the causes of death related to electrical injury?
- v- fib
- cardio respiratory failure
Pt has previous history of cancer treatment for prostate cancer. The oncologist knows their is an increased risk for which secondary cancers (3)?
- Acute myeloid leukemia
- Myelodysplastic syndrome
- Solid tumors
What are 3 signs of secondary PEM ?
- depletion of SubQ
- wasting of quadricpes
- ankle or sacral edema
A 50-year-old female with a past medical history of hypertension comes to your clinic for a refill of her lisinopril medication. The patient’s vital signs are as follows: HR 80, BP 150/100, and BMI 40. Physical exam is remarkable for a large waist-to-hip. Her fasting lab results are as follows: Glucose: 200 mg/dL, Triglyceride: 200 mg/dL, Hemoglobin A1C: 7.0. The patient’s history, physical exam, and laboratory findings are most consistent with which of the following?
A. hyperthyroidism
B. type 1 DM
C. metabolic syndrome
D. cirrhosis of the liver
C. Metabolic syndrome
OBESITY (BMI>30 ) is main driver of metabolic syndrome
SXS: visceral fat, HTN, hyperinsulinemia, gluc. intolerance,. hypertriglyceridemia,
Low HDL
Increased climate change causeing heatwaves and air pollution increased the incidence of which diseases?
Cardiovascular, cerebrovascular, respiratory
Increased climate change causing crop failures and high temps increased the incidence of which diseases?
vector borne infections (malaria, dengue)
What is the trend for cardiovascular disease, cancer and HIV/AIDS? (increase/ decrease)
INCREASE for all of them
Which disease trends decreased ?
- neonatal conditions
2. diarrhea, common infectious disease
Which outdoor pollutant results in increased ROS in lower respiratory tract?
OZONE
Why should pregnant women avoid consuming seafood?
high levels of methyl mercury, can causes Minamata disease of children
What is minamata diease?
due to methyl mercury (from FISH or DENTAL AMALGAMS)
causes mental retardation, deafness, blindness, cerebral palsy in children
What environmental pollutant causes Itai -itai ?
cadmium ( from batteries, soil, plants, food)
Scattered petechiae, tinniitus , episodes of dizziness are all associated with toxicity of which drug?
Chronic salicyate poisoning (aspirin)
What are symptomatic results of anorexia nervosa?
- cold intolerance (decreased thyroid hormone
- anemia
- amenorrhea
- . decreased bone density
Cheilosis , glossitis and dermatitis , peripheral neuropathy is associated with which vitamin deficiency?
B6 (pyroxidine)
Megaloblastic anemia and degeneration of spinal cord tracts is associated with?
B12
20-30% CO saturation causes ___________ and 60-70% CO causes___________
- systemic hypoxia
2. unconciousness/ death
What size particles are readily inhaled into alveoli?
10 um
What outdoor pollutants make up smog ?
Sulfur dioxide Carbon monoxde OZONE Nitrogen dioxide lead / particulate matter
Rubber workers are at increased risk of leukemia due to exposure to ?
benzen and 1,3 butadiene
Exposire to chloroform and carbon tetrachloride via degreasing and cleaning agents cause________?
CNS depression and COma
Elevated levels of zinc protoporphoryin is used to diagnose?
Lead poisoning
The vascular constriction and increased vascular permeability in HYPOthermia results in ?
HYPOXIA and EDEMA
Lack of which gene results in failure to drive energy consumption leads to weight gain (obesity)?
MC4R
A diet in high animal fat and LOW fiber increases risk for what type of cancer?
COLON cancer
Characterize itai- itai ?
Osteoporosis and osteomalacia with renal dz
japanese
Mees lines are a sign of _________ poisoning?
ARSENIC : thy are lines on the nail beds
slide 32
Polycyclic hyrdocarbons are most potent carcinogens and increase risk of what 2 cancers?
lung and bladder
(+) Ferruginous bodies indicates?
Abestosis exposure
they are fibers coated in iRon
ACUTE effects of alcohol ?
CNS depression
steatosis
acute gastritis
CHRONIC effects of alcohol?
Thiamine deficiency alcoholic cardiomyopathy acute /chronic pancreatitis fetal alchol syndrome malnutrition ^^^ cancer
Centrolobular necrosis with accumulation of NAQP1 is seen with ?
Acetaminophen intoxication
Analgesic nephropathy and ringing in the ears is associated with ?
CHRONIC aspirin toxicity
Acute aspirin toxicity: nausea/ coma
A 34-year-old woman is brought to the emergency department by her husband due to an altered mental status. The husband reports she recently had a change in dosage to her antipsychotic medication. Her temperature is 103°F (39.4°C), pulse is 105/min, and respirations are 26/min. She appears profusely diaphoretic and has muscle rigidity in her extremities. Which of the following is the preferred treatment?
- Medication for blood pressure
- RYR1 antagonist
- Electrolyte supplementation
- ATP antagonist
- This is malignant hyperthermia!
Causes INCREASE in body temp and muscle rigidity.
Often caused by general anesthetics
RYR1 antagonist= DANTROLENE
