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Nichols power points Flashcards

1
Q

Cherry red skin and mucous membranes

A

CO toxicity

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2
Q

what is the progression of signs of CO poisoning

A

headache –> nausea –> dizziness –> breathlessness –> collapse –> loss of consciousness

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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

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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

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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

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6
Q

what cancers are related to smoking

A

lung, oral, laryngeal, esophageal, bladder, breast, colon, kidney, liver, pancreas, cervical

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7
Q

what cancer is not associated w/ smoking

A

prostate

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8
Q

what dz presents w/ injurious accumulation of iron in hepatocytes b/c of excess iron absorption

A

hemochromatosis

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9
Q

what dz is an accumulation of iron b/c of some separate pathology

A

hemosiderosis

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10
Q

what 4 metals are associated w/ harmful effects in humans

A

Pb, Hg, As, Cd

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11
Q

are Pb, Hg, As, Cd visible as pigments in tissues?

A

No

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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

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13
Q

where do you see smokers macrophages

A

in the airspace

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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)

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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

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16
Q

what would you see on a pneumococcal pneumonia sputum gram stain

A

G+ cocci in pairs w/ faint capsule

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17
Q

what do toxins in cigarette smoke do (7)

A
  1. injure the mucociliary apparatus
  2. cause inflammation recruiting phagocytes
  3. inhibit anti-proteases needed to protect against protease tissue injury
  4. cause mucus production and secretion, yielding a place for bacteria to grow
  5. Inhibit phagocytosis and bacterial killing by phagocytes
  6. cause squamous metaplasia, removing mucociliary clearance of bacteria
  7. kill respiratory epithelial cells, removing a barrier to bacterial invasion
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18
Q

what do you call a RBC with black dots in it

A

basophilic stippling

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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)

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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

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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

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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

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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

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24
Q

How does low conc lead tox present in adults

A

short-term memory loss, difficulty concentrating, anxiety, phobias, irritability, depression, and hostility

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25
Q

adult comes in with short-term memory loss, very anxious and can’t concentrate … what does he have

A

low conc lead tox

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26
Q

what are the manifestations of high conc lead tox in adults

A

peripheral neuropathy (wrist/foot drop), myalgia, arthralgia, diffuse severe abdominal pain, constipation, renal insufficiency, anemia, headache, anorexia, & dec libido

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27
Q

adult presents w/ wrist drop then foot drop, myalgia, joint pain, & severe abdominal pain .. what does he have

A

high conc lead tox

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28
Q

what is the pathophys of lead tox

A
  • 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)
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29
Q

what causes basophilic stippling in lead poisoning

A

inhibition of pyrimidine 5’ nucleotidase can cause degradation of ribosomal RNA in RBCs

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30
Q

how do you differentiate between anemia from lead tox or iron def?

A

lead has basophilic stippling and high free/Zn protoporphyrin, iron def does not (both are hypo chromatic and microcytic)

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31
Q

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

A

pulmonary edema from heart failure

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32
Q

How does smoking cause atheromatous plaques

A

injures endothelium, hypercoaguable state

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33
Q

what do cigarette toxins do when they are in the blood stream (5)

A
  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
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34
Q

any form of nicotine can decrease what dz

A

ulcerative colitis

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35
Q

what system does nicotine harm

A

CV

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36
Q

what are a bunch of ADE of smoking

A

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

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37
Q

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

A

fetal alcohol syndrome

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38
Q

describe the facial features of fetal alcohol syndrome

A

small head, low nasal bridge, epicentral folds, small eye openings, flat mid face, underdeveloped jaw, short nose, thin upper lip, and smooth philtrum

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39
Q

name the 3 major characteristics of fetal alcohol syndrome

A
  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)
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40
Q

what are the 3 MC drugs used during pregnancy in order

A

cigarettes>alcohol>illicit drugs

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41
Q

picture shows hepatocytes distended w/ clear cytoplasm .. what is the dx

A

steatosis

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42
Q

what are the 3 MC causes of hepatic steatosis

A

alcohol, obesity, uncontrolled DM

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43
Q

how does alcohol cause hepatic steatosis

A
  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
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44
Q

on liver biopsy there is acute neutrophilic inflammation and some dying or dead hepatocytes w/ pyknotic nuclei .. what is the dx

A

steatohepatitis

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45
Q

what 5 ways does alcohol cause hepatitis

A
  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
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46
Q

what are mallory denk bodies made of and how do they appear

A

tangled skeins of deranged cytoskeletal cytokeratin intermediate filaments. come about when EtOH directly affects cytoskeleton organization

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47
Q

how does cocaine effect the CV system

A

blocks reuptake of NE

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48
Q

what does cocaine do in the brain

A

blocks reuptake of DA

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49
Q

HRT (estrogens and progestins)

A

inc risk of breast cancer

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50
Q

HRT (w/ or w/o progestins)

A

inc risk of thromboembolism

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51
Q

high NAPQI causes

A

centrilobular hepatic necrosis

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52
Q

red-brown liver

A

normal

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53
Q

tan-yellow liver

A

steatosis

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54
Q

liver biopsy w/ regenerative nodules and bridging fibrosis

A

cirrhosis

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55
Q

what percent of alcoholics get cirrhosis

A

15%

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56
Q

how long does it take to get cirrhosis w/ chronic alcoholism

A

15 yrs

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57
Q

pt comes in w/ what looks like cirrhosis but has only been an alcoholic for 4 years what does he have

A

NAFLD

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58
Q

rounded green/brown/tan mass in liver w/ cirrhosis

A

HCC

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59
Q

what would you see on microscopy of HCC

A

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

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60
Q

how often does HCC cause death in pts w/ alcoholic liver dz

A

rarely (3-6%)

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61
Q

what are a bunch of ADE of alcohol

A

intoxication, accidents, murder, suicide, panreatitis, liver dz, gastritis, alcoholic cardiomyopathy, peripheral neuropathy, FAS, cerebral atrophy, cerebellar degeneration, cancer of mouth, larynx, esophagus, breast, liver

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62
Q

starving child w/ fatty liver and large abdomen … dx and what causes it?

A

kwashiorkor from protein starvation

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63
Q

how does low protein cause kwashiorkor

A

lack of protein for lipoprotein synth causes lipid to accumulate in hepatocytes

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64
Q

starvation state of kwashiorkor can be masked by generalized edema primarily due to

A

decreased oncotic pressure

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65
Q

starvation w/ deprivation of all nutrients in proportion

A

marasmus

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66
Q

self imposed starvation w/ body dysmorphic disorder

A

anorexia nervosa

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67
Q

profound loss of lean body mass and fat due to cytokines principally TNF .. and what is the MCC

A

cachexia .. cancer

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68
Q

25 y/o WF med student completes an all-day national exam and suddenly feels famished .. this id due to ?

A

ghrelin

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69
Q

fasting lowers blood levels of

A

insulin

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70
Q

where is POMC produced

A

pituitary

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71
Q

how does leptin reduce hunger

A

stimulates POMC/CART neurons and inhibits NYP/AgRP neurons

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72
Q

other than reducing hunger what else does leptin do

A

increases energy expenditure by stimulating physical activity, energy expenditure, and thermogenesis

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73
Q

what hormone is a satiety signal from the gut

A

peptide YY

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74
Q

where is peptide YY released

A

post-prandially by endocrine cells in the ileum and colon

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75
Q

where is ghrelin produced

A

in the stomach

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76
Q

what does ghrelin do

A

stimulates appetite

77
Q

what can cause hypercalcemia

78
Q

what causes hypercalcemia in sarcoidosis

A

granulomas in the liver convert vit D to calcium (10% of sarcoid pts have it)

79
Q

how does high vit D present in kids

A

metastatic calcifications in soft tissues (kidney)

80
Q

how does high vit D present in adults

A

hypercalcemia and bone pain

81
Q

define obesity

A

BMI >30kg/m2 (severe obisity >40)

82
Q

what are the differences btw races and BMI scale

A

S asians are obese >25 and blacks may be healthy at BMI30 (their level is above 30)

83
Q

What BMI range is overweight for S asians

84
Q

people with abdominal obesity are more at risk for

A

heart dz, DM, HTN, dyslipidemia

85
Q

obese male w/ adipocytes though out liver biopsy

86
Q

what 2 dz are associated w/ NAFLD

A

insulin resistance (DM) and metabolic syndrome

87
Q

what defines metabolic syndrome

A

2 of following: obesity, insulin resistance, dyslipidemia, and HTN

88
Q

by what 3 mechanisms does insulin resistance cause TGs in hepatocytes

A
  1. impaired oxidation of fatty acids
  2. inc synth and reuptake of FA
  3. dec hepatic secretion of VLDL cholesterol
89
Q

what are the 2 types of gall stones

A

cholesterol stones and pigment stones

90
Q

what is the only significant pathway for the elimination of excess cholesterol

A

bile formation

91
Q

adipocytes make estrogen, which contributes to gallstone formation b/c estrogen increases…

A

hepatic uptake and synthesis of cholesterol

92
Q

obese WM smoker dies at 49 y/o biopsy shows 90% occlusion of vessel what is the cause

A

atherosclerosis

93
Q

what cytokines mediate metabolic syndrome

A

adiponectin, IL1, IL6, TNF

94
Q

what is adiponectin

A

anti-inflammatory cytokine produced exclusively by adipocytes. it enhances insulin sensitivity and inhibits inflammation.

95
Q

is adiponectin increased or decreased in metabolic syndrome

96
Q

what causes joint pain in obese people

A

osteoarthritis

97
Q

what joints are most affected by osteoarthritis in obese people

A

knees > hips

98
Q

stellate shaped mass w/ fat surrounding

A

breast cancer

99
Q

5 possible mechanisms for obesity to cause cancer

A
  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
Q

name a bunch of ADE of obesity

A

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
Q

Sun-setting sign

A

inc intracranial pressure (40% of hydrocephalus)

102
Q

how long does it take for neurons to run out of energy w/o blood supply

103
Q

what happens to ions in neurons after loss of blood supply

A

K out Ca in

104
Q

what causes the neurons to die when they loose blood supply

A

too much Ca inside

105
Q

how long does it take for 95% of the brain to become damaged after loss of blood supply

106
Q

3 things that happen after reperfusion of brain

A

inc Ca, ROS, edema through leaky blood vessels

107
Q

describe the process of anoxic encephalopathy

A

loss of blood supply –> inc Ca –> reperfuse (ROS, edema) –> inc ICP (cerebellar tonsillar herniation) –> compresses medulla (respiratory center) –> compressed brain necroses

108
Q

what causes death in cerebellar tonsillar herniation

A

compression of respiratory center

109
Q

fried egg on microscopy in brain

A

oligodendroglial cell

110
Q

what would you see on microscopy of anoxic encephalopathy

A

normal neurons, red (dead) neurons, & macrophages

111
Q

what would macrophages be eating in liquifactive necrosis

A

cell debris, myelin, hemosiderin

112
Q

What is a microscopic time table of a cerebral infarct

A

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
Q

severe dilation of ventricles associated w/ cerebral cortical atrophy … dx?

A

hydrocephalus

114
Q

what would a ruptured berry aneurism cause

A

subarachnoid hemmhorage

115
Q

what causes hydrocephalus in an adult

A
  1. sub arachnoid hemorrhage

2. tumor

116
Q

what causes hydrocephalus in a baby

A
  1. intraventricular matrix hemorrhage (premie)
  2. arnold-chiari malformation
  3. dandy-walker malformation
  4. spina bifida
117
Q

what causes hydrocephalus in an older child

A
  1. tumor

2. infection

118
Q

what would subdural hematoma look like on MRI

A

almost like a crescent shape on side of brain

119
Q

what is a hemorrhage of soft tissue due to rupture of blood vessels by blunt trauma

120
Q

what causes hemorrhage and necrosis in the temporal lobe

A

herpes encephalitis

121
Q

what does herpes encephalitis cause

A

necrotizing and hemorrhagic dz in the inferior and medial regions of temporal lobe and orbital gyri of the frontal lobes

122
Q

what dz causes oval nuclei containing lilac colored ground glass intranuclear inclusion and marginated native chromatin, and necrosis in the brain

123
Q

what are the common findings in HSV infection

A

3 Ms
Multinucleation, Molded nuclei, Marginated chromatin
Except brain, liver, and sometimes lung (only 1 nuclei)

124
Q

see pus on the brain

A

acute fibrinopurulent meningitis

125
Q

bacteria in brain no pus

A

acute pyogenic bacterial meningitis

126
Q

lymphocytes and a few macrophages and round clear cells containing faintly basophilic round structures in meningitis of AIDs pt

A

Cryptococcus neoformans meningitis

127
Q

how do you dx cryptococcus infection

A

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
Q

what are the microscopic findings in the brain of an AIDS pt w/ dementia that would explain the dementia

A

microglial nodule and perivascular macrophages (containing viral proteins)

129
Q

what is the predominant cell type in brain that is infected w/ HIV

130
Q

you see round-oval eosinophilic or amphiphilic cytoplasmic inclusions containing viral proteins and RNA what are they and what dz are they characteristic for

A

negri bodies –> rabies

131
Q

perivascular cuffing

132
Q

what is the most common type of CNS primary lymphoma

A

diffuse large B-cell

133
Q

lesions on grey-white jxn of brain

A

metastasis

134
Q

what are CNS primary lymphomas most likely going to exibit

A

angiotropic and angioinvasive nature

135
Q

what are the most common primary sites of metastasis to brain in order

A

Lung > breast > skin (melanoma) > kidney > GI

136
Q

psamomma bodies in brain

A

meningioma

137
Q

pt presents w/ rapidly progressive dementia and shows to have numerous vacuoles in neutrophils

A

spongiform encephalopathy (CJdz)

138
Q

places of loose eosinophilic material that form around a core of A-beta amyloid

A

alzheimers

139
Q

tumor near the 4th ventricle

A

ependymoma

140
Q

perivascular pseudorosettes

A

ependymoma

141
Q

cellular w/ sheets of anapestic small round blue cells in brain

A

medulloblastoma

142
Q

homer wright rosette

A

medulloblastoma

143
Q

primative tumor cells surrounding central neutropil

A

homer wright rosettes

144
Q

“hole in brain” w/ enhancing around lesion on CT

145
Q

how do you tx abscess

A

drain –> get gram stain & culture for aerobes, anaerobes, fungi, & mycobacteria

146
Q

what would you see on microscopy of a sample from an abscess

A

neutrophils

147
Q

insidious onset of headaches, microscopy reveals palisaded lymphocytes (little blue dots) around a largely acellular area of necrosis .. dx?

A

Glioblastoma

148
Q

NMYC gene amplification

A

neuroblastoma (glioblastoma)

149
Q

NF1 mutation

A

neurofibroma (Neurofibromatosis type 1)

150
Q

germline CDKN2A present in

A

25% of melanoma prone kids

151
Q

tumoral CDKN2A deletion

A

Glioblastoma & pancreatic tumor

152
Q

where does CDKN2A cause tumor growth in the cell cycle

153
Q

who gets neuroblastomas

154
Q

who gets glioblastomas

155
Q

Giant cells in brain tumor

A

glioblastoma

156
Q

what is the differential for a ring-enhancing lesion in the brain

A 
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
Q

Whats the difference btw stertorous breathing and stridor

A
  • 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
Q

what is the most common cause of brain abscesses

A

polymicrobial (mix of aerobic and anaerobic oral flora)

159
Q

person on safari in kenya and develops fever and chills that recurs every 3 days

160
Q

kid w/ crampy abdominal pain and diarrhea that on microscopy shows up w/ 2 nuclei and 4 flagella

161
Q

what is the most common pathogenic parasitic infection in humans, spread by fecally contaminated by food or water

A

giardiasis

162
Q

what is the differential dx for a mexican immigrant w/ anemia

A
  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
Q

what is the ddx for bilateral peripheral nodular infiltrates

A
  1. TB
  2. histoplasmosis
  3. sarcoidosis
  4. staph aureus
  5. pneumococcus
  6. granulomatosis w/ polyangiitis
  7. metastases
164
Q

what is a complication of giving an anemic person who is hemolyzing RBCs a transfusion

165
Q

cough, eosinophilia, trasient pulmonary infiltrates .. what is the syndrome and what causes it

A

loefflers syndrome. ascarias lumbricoides

166
Q

what is the most common parasitic worm infection in the world

A

Ascarias lumbricoides

167
Q

what is the 2nd most common parasitic worm infection in the world

168
Q

where does whip worm stay in the body

169
Q

what causes diarrhea (blood streaked), anemia, eosinophilia, hypoalbuminemia, and hypergammaglobulinemia

170
Q

what would increased thickness of airspace walls cause

171
Q

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

A

pneumocystis jiroveci pneumonia

172
Q

what would pneumocystis jiroveci pneumonia show on blood test

173
Q

cup shaped or helmet shaped looking cells on silver stain

A

pneumocystis jiroveci

174
Q

what causes sloughing of dead respiratory epithelium

175
Q

what is the legal limit to drive
what is the BAL of drowsiness
What is the BAL of stupor

A

80, 200, 300

176
Q

alveoli filled w/ fibrinopurulent exudate and G+ diplococci

A

pneumococcal pneumonia

177
Q

how is influenza spread

178
Q

abrupt onset of fever, headache, myalgia, malaise (after 2 days of incubation). can be accompanied by respiratory tract illness (cough, sore throat, nasal discharge)

179
Q

how does flu cause 2ndary infection in the lung

A

flu kills respiratory epithelial cells knocking out mucociliary elevator for clearing bacteria from LRT

180
Q

grocott stain

181
Q

large cells w/ basophilic nuclear inclusions w/ halos and granular basophilic cytoplasmic inclusions

A

cmv infected macrophages

182
Q

IC pt w/ mono-like illness, fever, atypical lymphocytosis, lymphadenopathy, and hepatomegaly accompanied by abnormal LFTs

183
Q

friable mass of tan and light/dark brown material in collapsed, scarred cavity of lung

A

aspergillosis

184
Q

septate fungal hyphae w/ acute angle branching

A

aspergillosis

185
Q

what are the 2 distinct forms of aspergilosis

A
  1. colonizing
  2. allergic
  3. invasive
186
Q

what is colonizing aspergillosis

A

fungus ball that fills cavity

187
Q

allergic aspergillosis .. describe

A

bronchopulmonary, w/ associated eos

188
Q

invasive aspergillosis .. describe

A

IC pt … lung –> blood vessels; causes hemorrhages, infarcts, and can disseminate to brain

189
Q

conidiophores

A

aspergilosis

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