Nichols power points Flashcards
Cherry red skin and mucous membranes
CO toxicity
what is the progression of signs of CO poisoning
headache –> nausea –> dizziness –> breathlessness –> collapse –> loss of consciousness
how does CO poison the body
CO binds to Hb 200x better than O2 and blocks O2 binding, transport and delivery to tissues who need it
how do the symptoms of CO poisoning change with levels of CO
20-30% of Hb saturated w/ CO = systemic hypoxia (headache & exertional dyspnea)
60-70% of Hb saturated w/ CO = comma and death
How does smoking cause emphysema
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
what cancers are related to smoking
lung, oral, laryngeal, esophageal, bladder, breast, colon, kidney, liver, pancreas, cervical
what cancer is not associated w/ smoking
prostate
what dz presents w/ injurious accumulation of iron in hepatocytes b/c of excess iron absorption
hemochromatosis
what dz is an accumulation of iron b/c of some separate pathology
hemosiderosis
what 4 metals are associated w/ harmful effects in humans
Pb, Hg, As, Cd
are Pb, Hg, As, Cd visible as pigments in tissues?
No
what dz causes large numbers of Macrophages w/ dusty brown and black pigment in them and few lymphocytes to be in the bronchiolar lumen
respiratory bronchiolitis
where do you see smokers macrophages
in the airspace
what do you call cells in a lung biopsy that are filled with what looks like iron
hemosiderin-laden macrophage (heart failure cells)
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
Pneumonia … pneumococcus
what would you see on a pneumococcal pneumonia sputum gram stain
G+ cocci in pairs w/ faint capsule
what do toxins in cigarette smoke do (7)
- 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
what do you call a RBC with black dots in it
basophilic stippling
what is basophilic stippling of RBCs and what causes it
clumped ribosomes & lead poisoning (also megaloblastic anemia due to vit B12 def or folate def)
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
low conc lead tox
what are the manifestations of low conc lead tox in kids
cognitive impairment (memory), behavior problems (hyperactivity), decreased verbal ability, hearing loss, irritability, lethargy, fatigue, myalgia, vomiting, and anemia
what are the manifestations of high conc lead tox in kids
colicky abdominal pain, arthralgia, renal insufficiency, constipation, tremor, headache, intellectual disability, seizures, coma, death
Kid comes in with abdominal pain, joint pain, constipation, and a very low IQ what does he have
high conc lead tox
How does low conc lead tox present in adults
short-term memory loss, difficulty concentrating, anxiety, phobias, irritability, depression, and hostility
adult comes in with short-term memory loss, very anxious and can’t concentrate … what does he have
low conc lead tox
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
adult presents w/ wrist drop then foot drop, myalgia, joint pain, & severe abdominal pain .. what does he have
high conc lead tox
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)
what causes basophilic stippling in lead poisoning
inhibition of pyrimidine 5’ nucleotidase can cause degradation of ribosomal RNA in RBCs
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)
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
How does smoking cause atheromatous plaques
injures endothelium, hypercoaguable state
what do cigarette toxins do when they are in the blood stream (5)
- injure endothelium, increasing permeability of lipids into arteries
- induce a procoagulant state
- increase HR, BP, & myocardial contractility which inc heart’s need for blood
- dec blood O2 carrying capacity
- play a role in causing 1/3 of MIs
any form of nicotine can decrease what dz
ulcerative colitis
what system does nicotine harm
CV
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
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
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
name the 3 major characteristics of fetal alcohol syndrome
- specific dysmorphic facial features
- growth retardation
- CNS abnormalities (wide range of neurobehavioral problems including impairment of self-regulation, cognition, and adaptive fxning)
what are the 3 MC drugs used during pregnancy in order
cigarettes>alcohol>illicit drugs
picture shows hepatocytes distended w/ clear cytoplasm .. what is the dx
steatosis
what are the 3 MC causes of hepatic steatosis
alcohol, obesity, uncontrolled DM
how does alcohol cause hepatic steatosis
- 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
- impaired assembly and secretion of lipoproteins
- impaired peripheral catabolism of fat
on liver biopsy there is acute neutrophilic inflammation and some dying or dead hepatocytes w/ pyknotic nuclei .. what is the dx
steatohepatitis
what 5 ways does alcohol cause hepatitis
- ACETALDEHYDE induces lipid peroxidation and acetaldehyde-protein adduct formation which may disrupt cytoskeleton and membrane fxn
- EtOH DIRECTLY affects cytoskeleton organization (malory denk bodies), mt fxn, & membrane fluidity
- ROS generated during oxidation of ethanol by the microsomal ethanol oxidizing system react w/ and damage membranes and proteins
- CYTOKINE-MEDIATED INFLAMMATION
- TNF is main effector of injury (IL-1, IL-6, & IL-8 may also contribute
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
how does cocaine effect the CV system
blocks reuptake of NE
what does cocaine do in the brain
blocks reuptake of DA
HRT (estrogens and progestins)
inc risk of breast cancer
HRT (w/ or w/o progestins)
inc risk of thromboembolism
high NAPQI causes
centrilobular hepatic necrosis
red-brown liver
normal
tan-yellow liver
steatosis
liver biopsy w/ regenerative nodules and bridging fibrosis
cirrhosis
what percent of alcoholics get cirrhosis
15%
how long does it take to get cirrhosis w/ chronic alcoholism
15 yrs
pt comes in w/ what looks like cirrhosis but has only been an alcoholic for 4 years what does he have
NAFLD
rounded green/brown/tan mass in liver w/ cirrhosis
HCC
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
how often does HCC cause death in pts w/ alcoholic liver dz
rarely (3-6%)
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
starving child w/ fatty liver and large abdomen … dx and what causes it?
kwashiorkor from protein starvation
how does low protein cause kwashiorkor
lack of protein for lipoprotein synth causes lipid to accumulate in hepatocytes
starvation state of kwashiorkor can be masked by generalized edema primarily due to
decreased oncotic pressure
starvation w/ deprivation of all nutrients in proportion
marasmus
self imposed starvation w/ body dysmorphic disorder
anorexia nervosa
profound loss of lean body mass and fat due to cytokines principally TNF .. and what is the MCC
cachexia .. cancer
25 y/o WF med student completes an all-day national exam and suddenly feels famished .. this id due to ?
ghrelin
fasting lowers blood levels of
insulin
where is POMC produced
pituitary
how does leptin reduce hunger
stimulates POMC/CART neurons and inhibits NYP/AgRP neurons
other than reducing hunger what else does leptin do
increases energy expenditure by stimulating physical activity, energy expenditure, and thermogenesis
what hormone is a satiety signal from the gut
peptide YY
where is peptide YY released
post-prandially by endocrine cells in the ileum and colon
where is ghrelin produced
in the stomach