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COM: MOD II - Midterm COPY > Chapter 9 > Flashcards

Chapter 9 Flashcards

1
Q

What type of fat is associated with more bad health problems?

A

Visceral fat (central obesity) is associated with more bad health problems than is subcutaneous fat

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2
Q

Alcohol is metabolized by 3 different mechanisms. What is responsible for the metabolism of alcohol in the ER versus the cytoplasm?

A

CYPs in the ER

Alcohol dehydrogenase in the cytoplasm

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3
Q

High animal fat intake with low fiber intake is related to what type of cancer?

A

Colon cancer

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4
Q

What happens to pts body fluids after a burn?

A
  • they shift into the interstitial compartments, both at the burn site and systemically due to the systemic inflammatory response syndrome, leading to shock
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5
Q

What effects does chronic alcoholism have on the liver?

A
  • hepatic steatosis
  • alcoholic hepatitis and cirrhosis
  • cirrhosis is associated with portal hypertension and an increased risk for development of hepatocellular carcinoma
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6
Q

What is the most toxic form of arsenic and what is it also the frontline treatment for?

A
  • arsenic trioxide, sodium arsenite and arsenic trichloride

- arsenic trioxide is also a frontline treatment for acute promyelocytic leukemia

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7
Q

Explain the presentation of acute alcoholism

A
  • hepatic steatosis
  • acute gastritis and ulceration of stomach
  • in CNS, subcortical structures affecting high brain stem RF affected first then with progressively higher levels of alcohol, cortical neurons and lower medullary centers are depressed
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8
Q

Occupational exposure to what toxicants causes nasal cancer?

A

Isopropyl alcohol and wood dust

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9
Q

What does acute salicylate (aspirin) overdose cause?

A

Alkalosis as a consequence of the stimulation of the respiratory center in the medulla

Salicylate -> hyperventilation -> pure respiratory alkalosis

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10
Q

What are the symptoms of vinyl chloride exposure?

A

Hepatic angiosarcoma (uncommon type of hepatic tumor) -> high yield

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11
Q

Explain Kwashiorkor

A
  • marked protein deprivation is associated with severe depletion of the visceral protein compartment
  • happens when protein deficiency is more severe than caloric deficit
  • hypoalbuminemia is seen -> generalized/dependent edema -> loss of weight is masked by edema
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12
Q

What is the major complication of anorexia nervosa and bulimia?

A

Cardiac arrhythmia and sudden death resulting from hypokalemia

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13
Q

What effects does chronic alcoholism have on vitamin levels?

A
  • Thiamine (vitamin B1) defeficiency is common
  • principal lesions from this deficiency are peripheral neuropathies and Wernicke-Korsakoff syndrome
  • cerebral atrophy, cerebellar degeneration and optic neuropathy may also occur
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14
Q

What are the 2 phases of how Xenobiotics work?

A

Phase 1: chemicals undergo hydrolysis, oxidation or reduction. Done by CYP

Phase : Products of phase I are converted into water soluble compounds -> glucuronidation, sulfation, methylation, and conjugation with glutathione (conjugation)

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15
Q

Agents in smoke have a direct irritant effect on the ______________ mucosa. Cigarette smoke also causes the recruitment of _____________

A

Tracheobronchial mucosa; leukocytes

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16
Q

Explain the morphology of rickets during the non-ambulatory stage of infancy

A
  • occipital bones flattening and parietal bones buckle inward by pressure
  • frontal bossing and a square head
  • deformation of the chest comes from an overgrowth of cartilage or osteoid tissue that produces rachitic rosary**
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17
Q

What is the direct product of alcohol oxidation?

A

Acetaldehyde

**Responsible for some of the acute effects of alcohol and for the development of oral cancers

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18
Q

What is a microsome?

A

Liver cells homogenized -> in ER and have CYP2E1 for metabolizing alcohol

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19
Q

What are the clinical features of iron deficiency?

A

Hypochromic microcytic anemia

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20
Q

Chronic alcoholism is associated with increased incidence of what types of cancers?

A

Cancer of the oral cavity, esophagus, liver and in women, possibly the breast

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21
Q

What are direct versus indirect causes of injury from hypothermia?

A
  • indirect causes result from circulatory changes that depend on the rate and duration of chilling
  • direct causes are mediated by physical disruption within cellls by high salt concentrations caused by the crystallization of IC and EC water
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22
Q

What effects does chronic alcoholism have on the CV system?

A
  • injury to myocardium may produce dilated congestive cardiomyopathy (alcoholic cardiomyopathy)
  • increased HTN
  • decreased levels of HDL, increasing likelihood of coronary heart disease
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23
Q

Explain the mutations associated with alcohol dehydrogenase

A
  • ~50% of Asians have very low alcohol dehydrogenase due to ALDH22 variant (normal allele is ALDH21)
  • one copy of ALDH2*2 reduces acetaldehyde dehydrogenase activity significantly
  • individuals who are homozygous for ALDH2*2 are completely unable to oxidize acetaldehyde and cant tolerate alcohol -> causes nausea, flushing, tachycardia and hyperventilation
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24
Q

What other cancers are associated with tobacco?

A 
Mouth and esophagus 
Pancreas 
Kidney and bladder 
Cervix 
BM
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25
Q

What effects does chronic alcoholism have on the pancreas?

A
  • increased risk of acute and chronic pancreatitis
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26
Q

Explain the morphology of rickets during the ambulatory stage of kids

A
  • likely to affect the spine, pelvis and tibia that causes lumbar lordosis and bowing of the legs
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27
Q

Occupational exposure to what toxicants cause lung cancer?

A 
Radon
Asbestos
Arsenic
Chromium
Silica
Bis(chloromethyl)ether
Nickel
Mustard gas 
Uranium
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28
Q

What is the main MOA for cigarette smoke causing malignancies?

A

CYPs facilitate excretion of carcinogens however some intermediates produced by CYPs are electrophilic and form DNA adducts which are cancer causing chemicals ionically bonded to DNA

**Benzopyrene DNA adduct in lung cancer

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29
Q

What is the main CYP involved in the metabolism of alcohol and where is it found?

A

CYP2E1; found in the ER of the liver (microsomes)

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30
Q

What is heat exhaustion?

A
  • a symptom of dehydration
  • sudden onset, with prostration and collapse
  • exhaustion is less severe than a stroke, drink a glass of cold water and you’ll be fine -> “reversible after water repletion”
  • results from a failure of the CV system to compensate for hypovolemia caused by dehydration
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31
Q

What vitamin deficiency is common in chronic alcoholics?

A

Vitamin B1 (thiamine) deficiency -> leads to peripheral neuropathies, Wernicke-Korsakoff syndrome, cerebral atrophy, cerebellar degeneration and optic neuropathy

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32
Q

What are the 3 enzyme systems in the liver that metabolize alcohol and which is the most common?

A

Alcohol dehydrogenase -> most common
Microsomal ethanol-oxidizing system -> occurs at high blood alcohol levels
Catalase -> minor importance

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33
Q

Mercury can lead to _________ disease. Explain this disease

A

Minamata disease -> cerebral palsy, deafness, blindness, mental retardation and major CNS defects for fetuses; the developing brain is extremely sensitive to methyl mercury

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34
Q

What is arcuate exposure to CO characterized by?

A

Cherry-red color o the skin and mucous membranes bc of elevated levels of carboxyhemoglobin

  • masks the underlying oxygen-starved state and makes visual Dx difficult
  • manipulated in the meat industry to keep meat looking bright red and fresh
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35
Q

______________ is considered to be the main agent associated with alcohol-induced laryngeal and esophageal cancer

A

Acetaldehyde

**Individuals with one copy of the ALDH2*2 allele who drink are at a higher risk for developing cancer of the esophagus

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36
Q

Explain a heat stroke

A
  • associated with high ambient temps, humidity, and exertion
  • thermoregulatory mechanisms fail, sweating ceases and the body temp rises to more than 40 degrees -> multiorgan dysfunction
  • marked generalized vasodilation, peripheral pooling of blood, and decreased effective circulating volume
  • strokes are worse than exhaustion, and you will have irreversible, multiorgan systems not seen in exhaustion
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37
Q

What organs are affected by arsenic exposure and what organs are susceptible to cancer after chronic arsenic exposure?

A
  • arsenic causes acute GIT, CV and CNS toxicities that are often fatal
  • chronic exposure to arsenic increases the risk of cancers of the lungs, bladder and skin; skin tumors are different from those produced by UV light, arsenic induced tumors are often multiple tumors on the palms and soles
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38
Q

Exposure to an isocyanate-based paint spray without any exhaust ventilation or respiratory protection can cause what?

A

Asthma

**once you begin to use appropriate respiratory protection and ventilation equipment work can continue without symptoms

39
Q

What are the MCV and MCH values associated with microcytic anemia and exposure to what metal causes this?

A

MCV = <80fL
MCH = <27 pg
Microcytic hypochromic anemia is caused by lead poisoning

40
Q

The use of ethanol during pregnancy can cause fetal alcohol syndrome, what are the sx of this?

A
  • Microcephaly, Growth retardation and facial abnormalities in the newborn
  • reduction in mental functions as the child grows older

**consumption during the first trimester of pregnancy is particularly harmful

41
Q

How does chronic alcoholism affect the GI tract?

A

Causes massive bleeding from gastritis, gastric ulcer or esophageal varices

42
Q

Explain the metabolism of alcohol

A
  • ethanol is absorbed unaltered in the stomach and small intestine
  • it is then distributed to all tissues and fluids in the body in direct proportion to the blood level
  • the rate of metabolism affects the blood alcohol level
  • most of the alcohol in the blood is oxidized to acetaldehyde in the liver by 3 enzyme systems
43
Q

Chronic alcoholism is related principally to damage of what organs?

A 
Liver 
GI tract 
CNS
CV system
Pancreas
44
Q

What is malignant hyperthermia?

A

Inherited mutation in RYR1 that causes there to be a heat-stroke-like increase in the core body temp from muscle contractures after given volatile inhaled anesthetics with succinylcholine (SUX)

45
Q

Occupational exposure to what chemical causes leukemia?

A

Benzene

46
Q

Why can acetaminophen toxicity occur in lower doses in alcoholics?

A

Bc in alcoholics alcohol induces CYP2E in the liver

47
Q

How is acetaminophen metabolized in the body?

A

It is detoxified from the system via phase II enzymes 95% of the time and is excreted in the urine as glucoronate or sulfate conjugates

48
Q

Exposure to Naphthylamines, 4-aminobiphenyl, benzidine or rubber products can cause what type of cancer?

A

Bladder cancer

49
Q

What are the major anatomic targets of lead toxicity?

A

BM and blood, nervous system, GIT and renal

**blood and BM changes happen quickly and are very characteristic

50
Q

Where does acute alcoholism exert its effects mainly?

A

Mainly CNS but may induce hepatic and gastric changes that are reversible if alcohol consumption is discontinued

51
Q

How do oral contraceptives affect the risk of breast cancer, ovarian cancer and endometrial cancers?

A
  • doesnt increase risk of breast cancer
  • decreases risk of ovarian and endometrial cancers
  • HRT increases risk of ovarian and endometrial cancers
52
Q

What are the 2 main injuries from in an electrical injury?

A
  • burns if the current flow is sustained
  • ventricular fibrillation or cardiac and respiratory center failure resulting fro disruption of normal electrical impulses
53
Q

Explain the morphology of lead exposure

A
  • microcytic, hypochromic anemia from inhibition of heme synthesis that is usually accompanied by mild hemolysis
  • punctate (petechial) basophilic stippling of the RBCs
  • brain edema prone to occur in children
  • severe end of the spectrum in children
54
Q

An important characteristic of alternating current, the type of electricity supplied to most homes, is that it induces _____________

A

Muscle spasms -> causes irreversible clutching prolonging the period of current flow resulting in extensive electrical burns and in some cases spasm of the chest wall muscles producing death from asphyxia

  • currents generated from high voltage sources cause similar damage but are more likely to produce paralysis of medullary centers and extensive burns
55
Q

Differentiate between ionizing and nonionizing radiation

A
  • ionizing radiation has sufficient energy to remove tightly bound electrons -> main sources are X-rays, gamma rays, alpha particles and beta particles
  • nonionizing radiation moves atoms in a molecule or causes them to vibrate but isn’t sufficient to displace electrons from atoms -> UV and infrared light, microwaves and sound waves
56
Q

Explain the extent of damage caused by various types of ionizing radiation

A
  • alpha particles induce heavy damage in a restricted area
  • X-rays and gamma rays dissipate energy over a longer, deeper course and produce considerably less damage per unit of tissue
57
Q

What are the affects of ionizing radiation?

A

Fibrosis, mutagenesis, carcinogenesis and teratogenesis

58
Q

Differentiate between curie (Ci), Gray (Gy), and Sievert (Sv) (all units of radiation)

A
  • Curie = amount of radiation emitted by a source
  • Gray = energy absorbed by the target tissue per unit mass
  • Sievert = unit of equivalent dose that depends on the biologic effects of radiation -> provides uniform measure of biologic dose
59
Q

How does the field size of ionizing radiation affect injury?

A

Body can sustain relatively high doses when delivered to small, carefully shielded fields, whereas smaller doses delivered to larger fields may be lethal

60
Q

What tissues are most affected by ionizing radiation?

A

Tissues with a high rate of cell division -> gonads, bone marrow, lymphoid tissue, mucosa of the GI tract

61
Q

What is the major mechanism by which DNA is damaged by ionizing radiation?

A

Production of ROS from reactions with free radicals generated y radiolysis is of water -> poorly vascularized tissues with low oxygenation (like the cent3er of rapidly growing tumors, are generally less sensitive to radiation

62
Q

Explain the morphology of cells surviving radiant energy damage

A
  • mitotic spindle becomes disorderly
  • nuclear swelling and condensation and clumping of chromatin may appear
  • apoptosis may occur
  • giant cells may appear and persist yrs after exposure
  • at extremely high doses markers of cell death (pyknosis & lysis) appear
63
Q

Explain the cytoplasmic changes of cells exposed to ionizing radiation

A
  • cytoplasmic swelling
  • mito distortion
  • degeneration of ER
  • PM breaks and focal defects
64
Q

Explain the vascular changes of vessels exposed to ionizing radiation

A
  • during immediate postirradiation period, vessels may show only dilation
  • with time, or with higher doses endothelial cell swelling and vacuolation or even necrosis and dissolution of the walls of small vessels
  • affected vessels may rupture or thrombose
  • later endothelial cell proliferation and collagenous hyalinization and thickening of the intima resulting in marked narrowing or even obliteration of the vascular lumen; at this time an increase in interstitial collagen becomes evident, leading to scarring and contractions
65
Q

Explain the morphologic consequences of radiation injury on the brain

A

Adult = resistant

Embryo = destruction of neurons and glial cells (weeks to months)

66
Q

Explain the morphologic consequences of radiation injury on the skin

A

Erythema, edema (early)
Dyspigmentation (weeks to months)
Atrophy, cancer (months to years)

67
Q

Explain the morphologic consequences of radiation injury on the lungs

A

Edema
ARDS
Interstitial fibrosis (months to years)

68
Q

Explain the morphologic consequences of radiation injury on the LNs

A

Acute tissue loss

Atrophy and fibrosis (late)

69
Q

Explain the morphologic consequences of radiation injury on the GI tract

A

Mucosal injury (early)
Ulceration (early)
Fibrosis of wall (late)

70
Q

Explain the morphologic consequences of radiation injury on the testis

A

Destruction of spermatogonia, spermatids and sperm -> all occur early

71
Q

Explain the morphologic consequences of radiation injury on the ovaries

A

Destruction of germ cells and granulosa cells -> all occur early

72
Q

Explain the morphologic consequences of radiation injury on the gonads late after radiation

A

Atrophy and fibrosis of gonads

73
Q

Explain the morphologic consequences of radiation injury on the BM

A

Thrombocytopenia
Granulocytopenia
Anemia
Lymphopenia

**all occur early)

74
Q

Explain acute radiation syndromes

A

Higher levels of exposure cause health effects known as acute radiation syndromes, which at progressively higher doses involve the hematopoietic, GI and central nervous systems

75
Q

___________ and ____________ systems are extremely susceptible to radiation injury

A

Hematopoietic and lymphoid systems

76
Q

Where are the common sites of fibrosis after radiation treatment?

A
  • lungs
  • salivary glands after radiation for head and neck cancers
  • colorectal and pelvic areas after treatment for cancer of the prostate, rectum or cervix
77
Q

Risk of secondary cancers following irradiation is greatest in what population?

A

Children

78
Q

How does exposure to radon gas affect the body?

A

It is the product of spontaneous decay of uranium and its carcinogenic effects are attributable to 2 decay products, polonium 14 and polonium 218 which emit alpha particles
- decay products tend to deposit in the lung and chronic exposure in uranium miners may give rise to lung carcinomas

79
Q

What are the symptoms of vitamin A deficiency?

A 
Night blindness
Xerophthalmia 
Blindness
Squamous metaplasia
Vulnerability to infection, particularly measles
80
Q

What are the symptoms of vitamin D deficiency?

A

Rickets in children

Osteomalacia in adults

81
Q

What are the symptoms of vitamin E deficiency?

A

Spinocerebellar degeneration

82
Q

What are the symptoms of vitamin B1 deficiency?

A

AKA thiamine
Dry and wet beriberi
Wernicke syndrome
Korsakoff syndrome

83
Q

What are the symptoms of vitamin B2 deficiency?

A 
**AKA riboflavin**
Riboflavinosis
Cheilosis
Stomatitis
Glossitis
Dermatitis
Corneal vascularization
84
Q

What are the symptoms of vitamin B3 deficiency?

A

AKA niacin

Pellagra -> dementia, diarrhea, dermatitis

85
Q

What are the symptoms of vitamin B6 deficiency?

A 
**AKA pyridoxine**
Cheilosis 
Glossitis
Dermatitis
Peripheral neuropathy 
Maintenance of myelination oof SC tracts
86
Q

What are the symptoms of vitamin B12 deficiency?

A

Megaloblastic pernicious anemia and degeneration of posterolateral spinal cord tracts

87
Q

What are the symptoms of vitamin C deficiency?

A

Scurvy

88
Q

What are the symptoms of folate deficiency?

A

Megaloblastic anemia

Neural tube defects

89
Q

What are the symptoms of zinc deficiency?

A

Rash around eyes, mouth, nose and anus called acrodermatitis enteropathica
Anorexia and diarrhea
Growth retardation in children
Depressed mental function
Depressed wound healing and immune response
Infertility
Impaired night response

90
Q

What are the symptoms of iron deficiency?

A

Hypochromic microcytic anemia

91
Q

What are the symptoms of iodine deficiency?

A

Goiter and hypothyroidism

92
Q

What are the symptoms of copper deficiency?

A

Muscle weakness
Neurologic defects
Abnormal collagen cross-linking

93
Q

What are the symptoms of selenium deficiency?

A

Myopathy

Cardiomyopathy (Keshan disease(

COM: MOD II - Midterm COPY (4 decks)

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