Nichols power points Flashcards
(189 cards)
1
Q
Cherry red skin and mucous membranes
A
CO toxicity
2
Q
what is the progression of signs of CO poisoning
A
headache –> nausea –> dizziness –> breathlessness –> collapse –> loss of consciousness
3
Q
how does CO poison the body
A
CO binds to Hb 200x better than O2 and blocks O2 binding, transport and delivery to tissues who need it
4
Q
how do the symptoms of CO poisoning change with levels of CO
A
20-30% of Hb saturated w/ CO = systemic hypoxia (headache & exertional dyspnea)
60-70% of Hb saturated w/ CO = comma and death
5
Q
How does smoking cause emphysema
A
abnormal enlargement of airspaces due to destruction of the walls btw alveoli
- this is done by tobacco producing ROS which inactivates antiproteases (aka fxnal alpha1antitrypsin def) –> increased neutrophil elastase which causes tissue damage and emphysema
6
Q
what cancers are related to smoking
A
lung, oral, laryngeal, esophageal, bladder, breast, colon, kidney, liver, pancreas, cervical
7
Q
what cancer is not associated w/ smoking
A
prostate
8
Q
what dz presents w/ injurious accumulation of iron in hepatocytes b/c of excess iron absorption
A
hemochromatosis
9
Q
what dz is an accumulation of iron b/c of some separate pathology
A
hemosiderosis
10
Q
what 4 metals are associated w/ harmful effects in humans
A
Pb, Hg, As, Cd
11
Q
are Pb, Hg, As, Cd visible as pigments in tissues?
A
No
12
Q
what dz causes large numbers of Macrophages w/ dusty brown and black pigment in them and few lymphocytes to be in the bronchiolar lumen
A
respiratory bronchiolitis
13
Q
where do you see smokers macrophages
A
in the airspace
14
Q
what do you call cells in a lung biopsy that are filled with what looks like iron
A
hemosiderin-laden macrophage (heart failure cells)
15
Q
55 yr/o WM lawyer w/ Hx of smoking, EtOH use, & chronic cough comes to ER w/ increased sputum prod and purulence, & gradually increasing fever over 2 days … What does he have and what is causing it
A
Pneumonia … pneumococcus
16
Q
what would you see on a pneumococcal pneumonia sputum gram stain
A
G+ cocci in pairs w/ faint capsule
17
Q
what do toxins in cigarette smoke do (7)
A
- injure the mucociliary apparatus
- cause inflammation recruiting phagocytes
- inhibit anti-proteases needed to protect against protease tissue injury
- cause mucus production and secretion, yielding a place for bacteria to grow
- Inhibit phagocytosis and bacterial killing by phagocytes
- cause squamous metaplasia, removing mucociliary clearance of bacteria
- kill respiratory epithelial cells, removing a barrier to bacterial invasion
18
Q
what do you call a RBC with black dots in it
A
basophilic stippling
19
Q
what is basophilic stippling of RBCs and what causes it
A
clumped ribosomes & lead poisoning (also megaloblastic anemia due to vit B12 def or folate def)
20
Q
kid comes in w/ cognitive impairment (memory loss), hyperactivity, won’t talk much, won’t listen (hearing loss), irritability, lethargy, fatigue, myalgia, vomiting and anemia …. what does he have
A
low conc lead tox
21
Q
what are the manifestations of low conc lead tox in kids
A
cognitive impairment (memory), behavior problems (hyperactivity), decreased verbal ability, hearing loss, irritability, lethargy, fatigue, myalgia, vomiting, and anemia
22
Q
what are the manifestations of high conc lead tox in kids
A
colicky abdominal pain, arthralgia, renal insufficiency, constipation, tremor, headache, intellectual disability, seizures, coma, death
23
Q
Kid comes in with abdominal pain, joint pain, constipation, and a very low IQ what does he have
A
high conc lead tox
24
Q
How does low conc lead tox present in adults
A
short-term memory loss, difficulty concentrating, anxiety, phobias, irritability, depression, and hostility
25
adult comes in with short-term memory loss, very anxious and can't concentrate … what does he have
low conc lead tox
26
what are the manifestations of high conc lead tox in adults
peripheral neuropathy (wrist/foot drop), myalgia, arthralgia, diffuse severe abdominal pain, constipation, renal insufficiency, anemia, headache, anorexia, & dec libido
27
adult presents w/ wrist drop then foot drop, myalgia, joint pain, & severe abdominal pain .. what does he have
high conc lead tox
28
what is the pathophys of lead tox
- lead is electropositive and binds -SH groups and interferes w/ 2 enzymes in Heme synth --> high free protoporphyrins --> ANEMIA (electropositivity causes heme tox)
- divalent lead competes w/ Ca in mt respiration and various nerve fxns. this activates PKC which causes neurotoxicity (divalent competition w/ Ca fuses neurotoxicity)
29
what causes basophilic stippling in lead poisoning
inhibition of pyrimidine 5' nucleotidase can cause degradation of ribosomal RNA in RBCs
30
how do you differentiate between anemia from lead tox or iron def?
lead has basophilic stippling and high free/Zn protoporphyrin, iron def does not (both are hypo chromatic and microcytic)
31
65 y/o S asian M trader w/ Hx of smoking, HTN, obesity, DM, dyslipidemia comes to ER w/ squeezing substernal chest pain and dyspnea & bilateral plum crackles
pulmonary edema from heart failure
32
How does smoking cause atheromatous plaques
injures endothelium, hypercoaguable state
33
what do cigarette toxins do when they are in the blood stream (5)
1. injure endothelium, increasing permeability of lipids into arteries
2. induce a procoagulant state
3. increase HR, BP, & myocardial contractility which inc heart's need for blood
4. dec blood O2 carrying capacity
5. play a role in causing 1/3 of MIs
34
any form of nicotine can decrease what dz
ulcerative colitis
35
what system does nicotine harm
CV
36
what are a bunch of ADE of smoking
pulmonary emphysema, chronic bronchitis, COPD, bacterial pneumonia, HTN, Tachycardia, atherosclerotic CV dz, thromboangiitiss obliterans (buergers dz), spontaneous abortion, IUGR, preterm birth, prematurity, cancer of lung, larynx, mouth, esophagus, stomach, colon, pancreas, liver, kidney, bladder, breast, cervix
37
child presents with small head, low nasal bridge, epicentral folds, small eye openings, flat mid face, underdeveloped jaw, short nose, thin upper lip, and smooth philtrum … what does he have
fetal alcohol syndrome
38
describe the facial features of fetal alcohol syndrome
small head, low nasal bridge, epicentral folds, small eye openings, flat mid face, underdeveloped jaw, short nose, thin upper lip, and smooth philtrum
39
name the 3 major characteristics of fetal alcohol syndrome
1. specific dysmorphic facial features
2. growth retardation
3. CNS abnormalities (wide range of neurobehavioral problems including impairment of self-regulation, cognition, and adaptive fxning)
40
what are the 3 MC drugs used during pregnancy in order
cigarettes>alcohol>illicit drugs
41
picture shows hepatocytes distended w/ clear cytoplasm .. what is the dx
steatosis
42
what are the 3 MC causes of hepatic steatosis
alcohol, obesity, uncontrolled DM
43
how does alcohol cause hepatic steatosis
1. shunting of substates away from catabolism and toward lipid biosynthesis b/c of the generation of excess reduced NDAD resulting from metabolism of EtOH by alcohol dehydrogenase and acetaldehyde dehydrogenase
2. impaired assembly and secretion of lipoproteins
3. impaired peripheral catabolism of fat
44
on liver biopsy there is acute neutrophilic inflammation and some dying or dead hepatocytes w/ pyknotic nuclei .. what is the dx
steatohepatitis
45
what 5 ways does alcohol cause hepatitis
1. ACETALDEHYDE induces lipid peroxidation and acetaldehyde-protein adduct formation which may disrupt cytoskeleton and membrane fxn
2. EtOH DIRECTLY affects cytoskeleton organization (malory denk bodies), mt fxn, & membrane fluidity
3. ROS generated during oxidation of ethanol by the microsomal ethanol oxidizing system react w/ and damage membranes and proteins
4. CYTOKINE-MEDIATED INFLAMMATION
5. TNF is main effector of injury (IL-1, IL-6, & IL-8 may also contribute
46
what are mallory denk bodies made of and how do they appear
tangled skeins of deranged cytoskeletal cytokeratin intermediate filaments. come about when EtOH directly affects cytoskeleton organization
47
how does cocaine effect the CV system
blocks reuptake of NE
48
what does cocaine do in the brain
blocks reuptake of DA
49
HRT (estrogens and progestins)
inc risk of breast cancer
50
HRT (w/ or w/o progestins)
inc risk of thromboembolism
51
high NAPQI causes
centrilobular hepatic necrosis
52
red-brown liver
normal
53
tan-yellow liver
steatosis
54
liver biopsy w/ regenerative nodules and bridging fibrosis
cirrhosis
55
what percent of alcoholics get cirrhosis
15%
56
how long does it take to get cirrhosis w/ chronic alcoholism
15 yrs
57
pt comes in w/ what looks like cirrhosis but has only been an alcoholic for 4 years what does he have
NAFLD
58
rounded green/brown/tan mass in liver w/ cirrhosis
HCC
59
what would you see on microscopy of HCC
trabeculae and glandular structures of cells that look like hepatocytes, but w/ bigger nuclei and less cytoplasm and bile in some of the glandular structure lumens
60
how often does HCC cause death in pts w/ alcoholic liver dz
rarely (3-6%)
61
what are a bunch of ADE of alcohol
intoxication, accidents, murder, suicide, panreatitis, liver dz, gastritis, alcoholic cardiomyopathy, peripheral neuropathy, FAS, cerebral atrophy, cerebellar degeneration, cancer of mouth, larynx, esophagus, breast, liver
62
starving child w/ fatty liver and large abdomen … dx and what causes it?
kwashiorkor from protein starvation
63
how does low protein cause kwashiorkor
lack of protein for lipoprotein synth causes lipid to accumulate in hepatocytes
64
starvation state of kwashiorkor can be masked by generalized edema primarily due to
decreased oncotic pressure
65
starvation w/ deprivation of all nutrients in proportion
marasmus
66
self imposed starvation w/ body dysmorphic disorder
anorexia nervosa
67
profound loss of lean body mass and fat due to cytokines principally TNF .. and what is the MCC
cachexia .. cancer
68
25 y/o WF med student completes an all-day national exam and suddenly feels famished .. this id due to ?
ghrelin
69
fasting lowers blood levels of
insulin
70
where is POMC produced
pituitary
71
how does leptin reduce hunger
stimulates POMC/CART neurons and inhibits NYP/AgRP neurons
72
other than reducing hunger what else does leptin do
increases energy expenditure by stimulating physical activity, energy expenditure, and thermogenesis
73
what hormone is a satiety signal from the gut
peptide YY
74
where is peptide YY released
post-prandially by endocrine cells in the ileum and colon
75
where is ghrelin produced
in the stomach
76
what does ghrelin do
stimulates appetite
77
what can cause hypercalcemia
vit D
78
what causes hypercalcemia in sarcoidosis
granulomas in the liver convert vit D to calcium (10% of sarcoid pts have it)
79
how does high vit D present in kids
metastatic calcifications in soft tissues (kidney)
80
how does high vit D present in adults
hypercalcemia and bone pain
81
define obesity
BMI >30kg/m2 (severe obisity >40)
82
what are the differences btw races and BMI scale
S asians are obese >25 and blacks may be healthy at BMI30 (their level is above 30)
83
What BMI range is overweight for S asians
23-24.9
84
people with abdominal obesity are more at risk for
heart dz, DM, HTN, dyslipidemia
85
obese male w/ adipocytes though out liver biopsy
NAFLD
86
what 2 dz are associated w/ NAFLD
insulin resistance (DM) and metabolic syndrome
87
what defines metabolic syndrome
2 of following: obesity, insulin resistance, dyslipidemia, and HTN
88
by what 3 mechanisms does insulin resistance cause TGs in hepatocytes
1. impaired oxidation of fatty acids
2. inc synth and reuptake of FA
3. dec hepatic secretion of VLDL cholesterol
89
what are the 2 types of gall stones
cholesterol stones and pigment stones
90
what is the only significant pathway for the elimination of excess cholesterol
bile formation
91
adipocytes make estrogen, which contributes to gallstone formation b/c estrogen increases...
hepatic uptake and synthesis of cholesterol
92
obese WM smoker dies at 49 y/o biopsy shows 90% occlusion of vessel what is the cause
atherosclerosis
93
what cytokines mediate metabolic syndrome
adiponectin, IL1, IL6, TNF
94
what is adiponectin
anti-inflammatory cytokine produced exclusively by adipocytes. it enhances insulin sensitivity and inhibits inflammation.
95
is adiponectin increased or decreased in metabolic syndrome
decreased
96
what causes joint pain in obese people
osteoarthritis
97
what joints are most affected by osteoarthritis in obese people
knees > hips
98
stellate shaped mass w/ fat surrounding
breast cancer
99
5 possible mechanisms for obesity to cause cancer
1. ESTROGEN: fat produces ESTROGEN, inc risk of breast, endometrial and other cancers
2. IGF-1: obese people have inc insulin & IGF-1 in blood
3. LEPTIN: fat people have a lot of leptin which promotes proliferation
4. mTOR: fat cells have direct and indirect effects on growth regulators (mTOR & AMP-activated protein kinase)
5. INFLAMMATION: obese people have chronic low-level INFLAMMATION
100
name a bunch of ADE of obesity
DM (II), HTN, dyslipidemia, accelerated atherosclerotic CV dz, NAFLD, cholelithiasis, cholecystitis, osteoarthritis, obstructive sleep apnea, hypoventilation syndrome, DVT, thromboembolism, chonic pro-inflammatory state, GERD, urinary stress incontinence, infertility, depression , cancer of colon, breast, esophagus, thyroid, kidney, endometrium, gallbladder
101
Sun-setting sign
inc intracranial pressure (40% of hydrocephalus)
102
how long does it take for neurons to run out of energy w/o blood supply
3 mins
103
what happens to ions in neurons after loss of blood supply
K out Ca in
104
what causes the neurons to die when they loose blood supply
too much Ca inside
105
how long does it take for 95% of the brain to become damaged after loss of blood supply
15 mins
106
3 things that happen after reperfusion of brain
inc Ca, ROS, edema through leaky blood vessels
107
describe the process of anoxic encephalopathy
loss of blood supply --> inc Ca --> reperfuse (ROS, edema) --> inc ICP (cerebellar tonsillar herniation) --> compresses medulla (respiratory center) --> compressed brain necroses
108
what causes death in cerebellar tonsillar herniation
compression of respiratory center
109
fried egg on microscopy in brain
oligodendroglial cell
110
what would you see on microscopy of anoxic encephalopathy
normal neurons, red (dead) neurons, & macrophages
111
what would macrophages be eating in liquifactive necrosis
cell debris, myelin, hemosiderin
112
What is a microscopic time table of a cerebral infarct
12 hr: red neurons
24-48 hr: neutrophils
72hr-3wk: macrophages
3wk-3mo: astrocyte proliferation around empty space, w/ their processes forming wall around the hole left behind
113
severe dilation of ventricles associated w/ cerebral cortical atrophy … dx?
hydrocephalus
114
what would a ruptured berry aneurism cause
subarachnoid hemmhorage
115
what causes hydrocephalus in an adult
1. sub arachnoid hemorrhage
| 2. tumor
116
what causes hydrocephalus in a baby
1. intraventricular matrix hemorrhage (premie)
2. arnold-chiari malformation
3. dandy-walker malformation
4. spina bifida
117
what causes hydrocephalus in an older child
1. tumor
| 2. infection
118
what would subdural hematoma look like on MRI
almost like a crescent shape on side of brain
119
what is a hemorrhage of soft tissue due to rupture of blood vessels by blunt trauma
contusion
120
what causes hemorrhage and necrosis in the temporal lobe
herpes encephalitis
121
what does herpes encephalitis cause
necrotizing and hemorrhagic dz in the inferior and medial regions of temporal lobe and orbital gyri of the frontal lobes
122
what dz causes oval nuclei containing lilac colored ground glass intranuclear inclusion and marginated native chromatin, and necrosis in the brain
HSV
123
what are the common findings in HSV infection
3 Ms
Multinucleation, Molded nuclei, Marginated chromatin
Except brain, liver, and sometimes lung (only 1 nuclei)
124
see pus on the brain
acute fibrinopurulent meningitis
125
bacteria in brain no pus
acute pyogenic bacterial meningitis
126
lymphocytes and a few macrophages and round clear cells containing faintly basophilic round structures in meningitis of AIDs pt
Cryptococcus neoformans meningitis
127
how do you dx cryptococcus infection
CSF cryptococcal antigen (also can do on blood)
| also see budding yeast on pap stain, encapsulated in india ink prep, red capsule in mucicarmine stain
128
what are the microscopic findings in the brain of an AIDS pt w/ dementia that would explain the dementia
microglial nodule and perivascular macrophages (containing viral proteins)
129
what is the predominant cell type in brain that is infected w/ HIV
microglia
130
you see round-oval eosinophilic or amphiphilic cytoplasmic inclusions containing viral proteins and RNA what are they and what dz are they characteristic for
negri bodies --> rabies
131
perivascular cuffing
Rabies
132
what is the most common type of CNS primary lymphoma
diffuse large B-cell
133
lesions on grey-white jxn of brain
metastasis
134
what are CNS primary lymphomas most likely going to exibit
angiotropic and angioinvasive nature
135
what are the most common primary sites of metastasis to brain in order
Lung > breast > skin (melanoma) > kidney > GI
136
psamomma bodies in brain
meningioma
137
pt presents w/ rapidly progressive dementia and shows to have numerous vacuoles in neutrophils
spongiform encephalopathy (CJdz)
138
places of loose eosinophilic material that form around a core of A-beta amyloid
alzheimers
139
tumor near the 4th ventricle
ependymoma
140
perivascular pseudorosettes
ependymoma
141
cellular w/ sheets of anapestic small round blue cells in brain
medulloblastoma
142
homer wright rosette
medulloblastoma
143
primative tumor cells surrounding central neutropil
homer wright rosettes
144
"hole in brain" w/ enhancing around lesion on CT
abscess
145
how do you tx abscess
drain --> get gram stain & culture for aerobes, anaerobes, fungi, & mycobacteria
146
what would you see on microscopy of a sample from an abscess
neutrophils
147
insidious onset of headaches, microscopy reveals palisaded lymphocytes (little blue dots) around a largely acellular area of necrosis .. dx?
Glioblastoma
148
NMYC gene amplification
neuroblastoma (glioblastoma)
149
NF1 mutation
neurofibroma (Neurofibromatosis type 1)
150
germline CDKN2A present in
25% of melanoma prone kids
151
tumoral CDKN2A deletion
Glioblastoma & pancreatic tumor
152
where does CDKN2A cause tumor growth in the cell cycle
G1->S
153
who gets neuroblastomas
kids
154
who gets glioblastomas
adults
155
Giant cells in brain tumor
glioblastoma
156
what is the differential for a ring-enhancing lesion in the brain
```
M: metastasis
A: abscess
G: glioblastoma multiforme
I: infarct (sub acute phase)
C: contusion
D: demyelinating dz
R: radiation necrosis or resolving hematoma
L: lymphoma
```
157
Whats the difference btw stertorous breathing and stridor
- stertorous breathing is heavy snoring (hoarse sound) b/c of chronic nasal obstruction (seen in epilepsy)
- Stridor is high-pitched wheezing in upper air flow b/c of narrowed or obstructed flow
158
what is the most common cause of brain abscesses
polymicrobial (mix of aerobic and anaerobic oral flora)
159
person on safari in kenya and develops fever and chills that recurs every 3 days
Malaria
160
kid w/ crampy abdominal pain and diarrhea that on microscopy shows up w/ 2 nuclei and 4 flagella
giardia
161
what is the most common pathogenic parasitic infection in humans, spread by fecally contaminated by food or water
giardiasis
162
what is the differential dx for a mexican immigrant w/ anemia
1. anemia of chronic dz
2. iron def
3. folate or B12 def
4. malaria
5. myelodysplastic syndrome
6. autoimmune hemolytic anemia
7. aplastic anemia
163
what is the ddx for bilateral peripheral nodular infiltrates
1. TB
2. histoplasmosis
3. sarcoidosis
4. staph aureus
5. pneumococcus
6. granulomatosis w/ polyangiitis
7. metastases
164
what is a complication of giving an anemic person who is hemolyzing RBCs a transfusion
HF
165
cough, eosinophilia, trasient pulmonary infiltrates .. what is the syndrome and what causes it
loefflers syndrome. ascarias lumbricoides
166
what is the most common parasitic worm infection in the world
Ascarias lumbricoides
167
what is the 2nd most common parasitic worm infection in the world
whipworm
168
where does whip worm stay in the body
colon
169
what causes diarrhea (blood streaked), anemia, eosinophilia, hypoalbuminemia, and hypergammaglobulinemia
whipworm
170
what would increased thickness of airspace walls cause
dyspnea
171
alveoli filled w/ foamy exudate of cysts that contain small organisms and the interstitial is expanded w/ edema. Inflammatory infiltrate of lymphs and macros are also present
pneumocystis jiroveci pneumonia
172
what would pneumocystis jiroveci pneumonia show on blood test
hypoxemia
173
cup shaped or helmet shaped looking cells on silver stain
pneumocystis jiroveci
174
what causes sloughing of dead respiratory epithelium
influenza
175
what is the legal limit to drive
what is the BAL of drowsiness
What is the BAL of stupor
80, 200, 300
176
alveoli filled w/ fibrinopurulent exudate and G+ diplococci
pneumococcal pneumonia
177
how is influenza spread
aerosol
178
abrupt onset of fever, headache, myalgia, malaise (after 2 days of incubation). can be accompanied by respiratory tract illness (cough, sore throat, nasal discharge)
influenza
179
how does flu cause 2ndary infection in the lung
flu kills respiratory epithelial cells knocking out mucociliary elevator for clearing bacteria from LRT
180
grocott stain
fungus
181
large cells w/ basophilic nuclear inclusions w/ halos and granular basophilic cytoplasmic inclusions
cmv infected macrophages
182
IC pt w/ mono-like illness, fever, atypical lymphocytosis, lymphadenopathy, and hepatomegaly accompanied by abnormal LFTs
CMV
183
friable mass of tan and light/dark brown material in collapsed, scarred cavity of lung
aspergillosis
184
septate fungal hyphae w/ acute angle branching
aspergillosis
185
what are the 2 distinct forms of aspergilosis
1. colonizing
2. allergic
3. invasive
186
what is colonizing aspergillosis
fungus ball that fills cavity
187
allergic aspergillosis .. describe
bronchopulmonary, w/ associated eos
188
invasive aspergillosis .. describe
IC pt … lung --> blood vessels; causes hemorrhages, infarcts, and can disseminate to brain
189
conidiophores
aspergilosis
