Goljan High Yield 36 General EC Flashcards
Physiologic effects of hemorrhage
drop in diastolic blood pressure, activation of RAA system from decreased renal blood flow and catecholamine stimulation, catecholamine release from the high pressure baroreceptors, increased reabsorption of sodium from the kidneys, release of ANP, release of ADH
Opportunistic infections in AIDS
Pneumocystis CMV Cryptococcus MAI TB Herpes (esophagitis) Candida (thrush, esophagitis) Cryptosporidium (acid fast; diarrhea)
Decreased uptake of DOPA and NOR
Cocaine
Produces thymidine dimers
UVB light
If thymidine dimers not replaced with normal DNA by DNA repair enzymes, may result in cancer
ESR increase with age
Probably abnormal and indicates a disease process rather than being an age-related finding
Key elements in wound healing
Granulation Tissue and fibronectin
MCC of death in 15-25 age bracket
Motor vehicle
Homicide for black male
AR disease with absent DNA repair enzymes and increased incidence of UVB related skin cancer
Xeroderma pigmentosum
Inhibited by CO and cyanide
Cytochrome oxidase
XR disease with absent NADPH oxidase, absent respiratory burst, cannot kill catalase + S. aureus but can kill catalase negative strep
Chonic granulomatous disease
Type of necrosis in acute MI
Coagulation necrosis
Cause of atrophy in muslce
In a cast
Lack of muscle stimulation
Non-disjunction in somatic cells
Mosaicism
Mother gives disease to all her kids but son to none of his kids
Mitochondrial inheritance
MC vitamin deficiency in alcoholics
folate
MC metal deficiency in alcoholics
Magnesium
Vitamin associated with pyruvate dehydrogenase
Thiamin (required to make ATP)
NADPH oxidase conversion of molecular oxygen into superoxide free radicals. PMNs and monocytes only (no macrophages)
Respiratory burst
In Caisson disease, what is decreased when a diver comes up too quickly
pressure of N2 in blood since it forms bubbles in the vessels and moves into tissue
DES exposure, vaginal adenosis precursor
Clear cell adenocarcinoma of the vagina
What happens to the other kidney if one is damaged
It undergoes hypertrophy
Decreases the levels of vit K dependent factors, increased incidence of hemorrhagic strokes, potentiates the action of warfarin
Vit E toxicity
Required for carboxylase reaction in the conversion of pyruvate to oxaloacetate
Biotin
Involved in transamination reactions involving AST and ALT
Pyridoxine (B6)
Functions of ANP
opposite of ang-II
(inhibition of ADH release, inhibits ATII effect on stimulating thirst, inhibits aldosterone secretion, inhibits renal reabsorption of Na, and inhibits renin release
Chance of male with CF having a child. What about female?
<5% since the vas deferens never fully develop or are atretic
Females with CF can get pregnant but it is difficult owing to the thick cervical mucus
Vitamin supplements in CF
all of the fat soluble vitamins (D,A,E,K)
Woman is a pure vegan and is breast feeding her baby and the baby develops anemia
B12 deficiency
What does EBV attach to on B cells?
CD21
Hypogonadism, mental retardation, and unilateral gynecomastia
Klinefelter syndrome
Hypogonadism and color blindness
Kallman syndrome (absent GnRH)
Hypogonadism, mental retardation, retinitis pigmentosum
Laurence-Moon-Biedl syndrome
Male with hypogonadism, mental retardation, short stature, and webbed neck
Noonan syndrome (similar to Turner’s syndrome)
Hypogonadism and anosmia
Kallmann syndrome
Male pseudohermaphrodite with cryptorchidism
testicular feminization (absent androgen receptors (sex-linked recessive)
Most common cause of male pseudohermaphroditism
Microdeletion syndrome with hypogonadism, mental retardation, short stature, and obesity
Prader-Willi syndrome
Ch 15 deletion is of paternal origin
Patient with neurofibromatosis has severe diastolic hypertension
Pheochromocytoma
Complications of cyclophosphamide
hemorrhagic cystitis and transitional carcinoma of the bladder
Decline in deaths due to SIDS
Having baby sleep supine
(babies rebreathe their own CO2, those with immature central chemoreceptors do not respond to the respiratory acidosis by moving their heads and die)
Most important risk factor for increased morbidity/mortality in a single 25 year old black male
Unprotected sex
(AIDS #1 killer in this age bracket; also applies to women regardless of age, but not white men, where MVAs are #1 killer)
Several employees that work in a car assembly plant present with headache, nausea, vomiting, muscle weakness, and abdominal cramps
Lead poisoning from incineration of batteries; may change history to people making moonshine in an old car radiator
Newborn female presents with edema of the hands and feet and a cystic mass in the neck
Turner’s syndrome with a 45 XO karyotype
Compare to mature breast milk, cow’s milk has . . .
More vit K, B12, & Casein
Less ascorbic acid
(breast milk has low iron but it is better absorbed; casein is the key protein in cow’s milk, while whey is the primary protein in breast milk)
Vitamin that is absent in colostrum
Vit D
Anemia in an infant that develops when switched from cow’s milk to goat’s milk
Goat’s milk is low in folate, B6, iron
High in K, Cl, arachidonic acids, and linoleic acids
(when compared to cows milk)
Type of UV light with the greatest potential for producing a corneal burn
UVB
B is Bad
Retinal hemorrhages in young children
Possible child abuse (shaking syndrome)
Patient is stung by a bee and begins to have respiratory difficulty, flushing, and abdominal cramping. Treatment?
Aqueous epinephrine
Multiple wheals that later develop into vesicles and pustules
Fire ant bites
Painful bite (carrying some logs from outside, moving boxes in basement) followed by crampy pain in the thighs and abdomen
Black widow bite
Treat with muscle relaxant [Ca gluconate], tetanus prophylaxis, antivenin if available in severe case
In southwest, painful sting followed by local itching, paresthesias, N/V, and hypertesion
Scorpion bite
Painless bite beginning with a slightly tender red papular lesion on the arm that latter forms a hemorrhagic blister surrounded by purpura
Brown recluse spider bite
Extremely pruritic discrete, bright red papules on legs around the waist
Chigger bites
Child who ingested 30 adults aspirins will most likely develop
increased anion gap metabolic acidosis
(children unlike adults do not commonly develop mixed metabolic acidosis and respiratory alkalosis)
Treatment is to perform gastric lavage and add activated charcoal and to produce an alkaline urine for the increase excretion of the acid
What disease is more likely to infect the fetus after the first trimester
Syphilis
Engineer driving a train involved in a crash with an oncoming train was found to have THC metabolites in his urine- why did this occur
Delayed reaction time
it also impairs the ability to judge speed and distances
Angiosarcoma of the liver-causes?
Vinyl chloride
Arsenic
Thorotrast
Cardiovascular age dependent changes
loss of elasticity of aorta
Respiratory age dependent changes
obstructive findings
Musculoskeletal age dependent changes
Osteoarthritis
CNS age dependent changes
cataracts, presbycusis (inner ear degeneration) otosclerosis (conductive hearing loss) decreased smell and taste arcus senilis
Immune system age dependent changes
Increased CD4
Decreased CD8
Increased autoantibodies
Decreased cellular immunity
Integument age dependent changes
Loss of elasticity Increased collagen cross bridges Increased body fat Ecchymoses from vessel instability Decreased skin turgor
Reproductive age dependent changes
Breast and vulvovaginal atrophy
decreased serum estrogens and increased gonadotropins
Testicular atrophy with decreased testosterone levels, prostate hyperplasia
Renal age dependent changes
Decrease GFR (40%) Decreased creatinine clearance (important in dosing drugs to avoid toxicity)
Endocrine age dependent changes
Increased carbohydrate intolerance (less insulin receptors from increased adipose)
Target organs for acetaminophen injury
liver and kidneys (renal medulla)
Free radical injury
Low AFP
Down syndrome
Block phospholipase A2 hence decreasing prostaglandin and leukotriene production
Decrease leukocyte adhesion (increase PMNs, decrease lymphocytes and eosinophils)
Corticosteroids
Tumor marker that is a gene product (oncofetal antigen). Hepatocellular carcinoma, germ cell tumors, )yolk sac or endodermal sinus tumors of testicle or ovary). Testicular/ovarian cancer.
AFP
Tumor marker that is an enzyme. Hepatocellular carcinoma, yolk sac or endodermal sinus tumors of testicle or ovary
AAT
Tumor marker that is a hormone. Trophoblastic tumor in germ cell tumors of ovary/testis and placenta (benign=hyatidiform mole) (malignant=choriocarcinoma)
b-HCG
Tumor marker that is a protein. Small cell carcinoma of the lung, neuroblastoma
Bombesin
Tumor marker that is a protein. Multiple myeloma (excellent prognostic factor). Light chains in urine (Bence Jones protein)
B2-microglobulin
Tumor marker that is a glycoprotein (cancer antigen) in breast cancer
CA 15-3
Tumor marker that is a glycoprotein (cancer antigen) in pancreatic cancer (excellent marker)
CA 19-9
Tumor marker that is a glycoprotein (cancer antigen) in surface derived ovarian cancer
CA 125
Tumor marker that is a gene product (oncofetal antigen) in colorectal, pancreatic, breast, and SCC of the lung.
CEA
Bad prognostic sign if elevated preoperatively (greater incidence of undetected metastases)
Tumor marker that is an enzyme in Hodgkin’s disease (non-specific tumor marker in general)
LDH
Tumor marker that is an enzyme in SCC of the lung, and neuroblastoma
NSE (neuron specific enolase)
Tumor marker that is a glycoprotein in prostate adenocarcinoma.
PSA
Excellent sensitivity but poor specificity (increased in prostate hyperplasia)
Excellent indicator of tumor burden.
Not increased after rectal exam
Virus associated with adults T cell leukemia/lymphoma
HTLV-1 (RNA)
Virus associated with hairy cell leukemia
HTLV-2 (RNA)
RNA virus associated with CNS malignant lymphoma
HIV
RNA virus associated with hepatocellular carcinoma
HCV
Virus associated with hepatocellular carcinoma
HBV
aflatoxin B a cocarcinogen
DNA virus associated with Burkitt’s lymphoma, nasopharyngeal carcinoma, and polyclonal malignant lymphoma
EBV
DNA virus associated with SCC of the cervix, vagina, vulva, and anus in homosexuals. Laryngeal papillomas (may progress to cancer)
HPV (16&18)
DNA virus associated with Kaposi’s sarcoma
HSV-8
EM of zebra bodies in lysosomes in Niemann Pick disease
look like lamellar bodies in type II pneumocytes
Enamel injury in young woman
bulimia
Metabolic alkalosis from vomiting
Boerhaave’s syndrome
Secondary amenorrhea
Anorexia nervosa
Decreased GnRH and gonadotropins
Decreased protein intake but normal total caloric intake (all carbs).
Kwashiorkor
Fatty liver from decreased apolipoproteins, pitting edema, flaky paint dermatitis, “flag sign” in hair
Decreased total caloric intake. Loss of muscle mass
Marasmus
Squamous metaplasia in eyes, broncus, nyctalopia
Vit A deficiency
Increased intracranial pressure, hypercalcemia
Vit A deficiency
Yellow but sclera white
beta-carotenemia
*can be primary hypothyroidism from decreased conversion of B-carotenes into retinoic acid in the intestine (thyroxine is a cofactor)
Rickets vs osteomalacia
Craniotabes and rachitic rosary in rickets (not osteomalacia)
Both have increased unmineralized osteoid
Cerebellar dysfunction; hemolytic anemia
Vit E deficiency
Vit E toxicity
interferes with vit. K dependent factors leading to hemorrhagic diathesis (synergistic w/ warfarin)
Gums bleed when brushing teeth, glossitis, perifollicular hemorrhages, “tea and toast diet”
Vit. C deficiency
Thiamin deficiency
alcohol abuse MCC
Important biochemical reactions (need to make ATP): pyruvate dehydrogenase, transketolase, ketoglutarate, dehydrogenase
Ring hemorrhages in mamillary bodies and periventricular area
High output cardiac failure, congestive cardiomyopathy, peripheral neuropathy
Confusion, ataxia, nystagmus
Wernicke (thiamin deficiency)
Antegrade and retrograde memory deficits
Korsakoff (thiamin deficiency)
Niacin deficiency
Important biochemical reactions: NAD/NADH, NADP/NADPH
Pellagra
Tryptophan can be used to synthesize niacin (tryptophan decreased in Hartnup’s, carcinoid syndrome [converted to serotonin])
Riboflavin deficiency
Important biochemical reactions: FMN and FAD
Synthesis of glutathione
Magenta tongue, neovascularization of cornea, angular stomatits
Pyridoxine deficiency
INH MCC
Transaminase (heme synthesis)
Sideroblastic anemia w/ ringed sideroblasts, neurotransmitter synthesis
absent in goats milk
Important in fatty acid synthase complex (co-enzyme reactions)
Pantothenic acid
Biotin deficiency
Required for carboxylation reactions (ie gluconeogenesis)
avidin in raw eggs binds
causes alopecia
Chromium (functions and disorders)
part of the glucose tolerance factor which potentiates insulin activity
Deficiency associated with glucose intolerance and peripheral neuropathy
Copper Functions
Cofactor in many enzymes involved in oxidation-reduction reactions Lysyl oxidase-collagen cross links
Superoxide dismutase-
Ferroxidase- converts Fe2+ to Fe3+ so it can bind transferrin
Tyrosinase-conversion of tyrosine to DOPA
Copper deficiency clinical disorders
Deficiency associated with
Microcytic hypochromic anemia (cannot bind transferrin)
Skeletal abnormalities (defective collagen)
Osteoporosis
Skin depigmentation (problem with tyrosinase)
Dissecting aortic aneurysms (defective collagen and elastic tissue)
Mencke’s kinky hair syndrome (impaired utilization of copper)
Copper toxicity
Wilson’s disease
AR w/ defect in excretion of copper into bile. It leads to liver damage and eventual deposition of free copper into the eye (Kayer-Fleischer ring) and lenticular nuclei in the brain. Total copper levels are decreased owing to a decrease in ceruloplasmin synthesis by the damaged liver, but free copper levels are increased
Selenium functions
Functions in the metalloenzyme GLUTATHIONE PEROXIDASE which is an anti-oxidant that destroys peroxides in the cytosol. It neutralizes peroxides in the cytosol, while vitamin E prevents peroxide formation in the membranes of cells. It inhibits DNA synthesis and stimulates the immune system.
It is also an enzyme
cofactor in the peripheral conversion of T4 into T3
Selenium deficiency
Muscle pain
Weakness
Cardiomyopathy
Zinc function
Cofactor in Superoxide dismutase Carbonic anhydrase Alkaline phosphatase Collagenases Polymerases Thymidine kinase Alcohol dehydrogenase
Zinc deficiency
Growth retardation Hypogonadism and infertility Dysgeusia (decreased taste) Rash around eyes and mouth Impaired wound healing Impaired cellular immunity Deficiency is common in diabetics, alcoholics, and cirrhosis
Acrodermatitis enteropathica
Recessive disease characterized by decreased intestinal absorption of zinc
Goat’s milk
vit B6 (pyridoxine) and folate deficiency
Functions of Vit. C
Reduce dietary iron from ferric to ferrous for reabsorption
Hydroxylation of proline and lysine (binding site for cross-bridges)
Prevents nitrosamination
Reduces metHb
Cyanosis not relieved by oxygen in a patient coming home from a camping trip
methemoglobinemia (water has nitrites that oxidized iron to ferric condition)
SaO2 not PaO2 is decreased
Methylene blue treatment of choice (ascorbic acid ancillary role)
HbF
left shifts Hb ODC, protects newborns with sickle cell disease and severe beta-thalassemia, increased with hydroxyurea, resistant to alkali/acid denaturation
Raising the upper limit of normal of a test
Increases specificity and positive predictive value (decreases sensitivity and predictive value of a negative test result)
Prevalence
Number of people with disease in the population studied
=Incidence * duration of disease
What part of adrenal cortex is atrophies in a patient on corticosteroids?
Fasciculata and reticularis
not glomerulosa
Apoptosis
individual cell necrosis
Normal involution of structures (atrophy, thymus)
Programmed cell death
Loss of Mullerian structures in males and Wolffian in females
Councilman (acidophilic) bodies
Psammoma bodies
Mechanism of atresia in the bowel (no lumen)
Hypercalcemia as paraneoplastic syndrome
PTHrP from SCC of lung or renal adenocarcinoma
Acanthosis nigricans
Insulin resistance Stomach cancer (visceral malignancy)
Eaton-Lambert syndrome (Myasthenia-like)
Small cell carcinoma
Polymyositis paraneoplastic syndrome
Lung cancer
Oncogenesis in HPV
gene products E6 inhibits p53and E7 inhibits Rb
Metalloenzyme that aids tumor invasion of tissue
Type IV collagenase with Zinc cofactor
Smoker with history of peptic ulcer disease . . . advice?
Stop smoking
Normal karyotype in a child with Down syndrome
probable translocation w/ chromosome 21 sitting on top of ch 14
or acrocentric Robertsonian translocation of Ch 21
Sepsis in an elderly man with BPH
E. coli and can produce endotoxic shock
(warm shock due to activation of complement system and release of anaphylatoxins + release of NO from damaged endothelial cells)
DNA repair defects
Fanconi’s anemia (cross-linking agents)
Effect of barbiturates and other drugs that enhance P450s
decrease heme and increased activity of ALA synthase (rate limiting enzyme in heme synthesis)
Dangerous in precipitating porphyric attacks
Genomic imprinting
did chromosome come from mother or father (ie Ch 15 microdeletion syndromes - Prader Willi and Angelman)
Normal changes in pregnancy
Greater increase in PV than RBC mass leading to decreased Hb
Increased:
GFR
CCr
Alkaline phosphatase
Decreased BUN, creatinine, and uric acid
Respiratory alkalosis from progesterone effect
Increased T4 and cortisol from increased synthesis of their binding proteins (free hormone normal)
Main difference in adult male and female labs
iron studies all lower in females
Increased alkaline phosphatase (osteoblasts from bone growth) and phosphate. Slight decrease in Hb
Children
Analytes increased with hemolyzed blood sample
LDH
K
Lipid most affected by fasting
TG component coming from chylomicrons
CH and HDL not affected
Enhance cytochrome system in the SER of the liver
Alcohol
Barbiturates
Increase in serum GGT
Decreased drug levels from increased metabolism
inhibit cytochrome system
H2 blockers, proton blockers, danger of drug toxicity
First sign of tissue hypoxia
Swelling of cell from inactiva Na/K ATPase
Examples of growth alterations
Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia
Examples of cell accumulations
Melanin Fe Ca (dystrophic, metastatic) Glycogen Bilirubin products
Free radicals
Superoxide OH' Peroxide Acetaminophen Fe increases formation via Fenton reaction
Types of cell necrosis
Coagulation (infarction-exception CNS)
Liquefactive (infections, brain infarct)
Caseous (TB, fungi)
Enzymatic fat necrosis (acute pancreatitis)
Fibrinoid (immunologic injury:small vessel vasculitis, vegetations in RHD and Libman Sacks)
Gummatous (tertiary syphilis)
Chemical mediators of inflammation
Histamine C3a C3b C5a LTB4 LTC-D-E4 Bradykinin Prostaglandins
Factors increasing and decreasing adhesion molecule synthesis
Increase: C5a LTB4 Endotoxins IL-1 TNF
Decrease:
Catecholamines
Corticosteroids
Lithium
Circumscribed red lesion containing multinucleated giant cells
Granuloma
Type IV hypersensitivity
Macrophages when activates become epitheloid cells and fuse into multinucleated giant cells
Key factors in wound healing
Fibronectin and granulation tissue
MCC of delayed wound healing
Infection
Suppurative inflammation
abscess (s. aureus)
Cellulitis inflammation
strep pyogenes
Granulomatous inflammation cause
TB/systemic fungi
Pseudomembranous inflammation causes
diphtheria
C. dif
Fibrinous inflammation example
pericarditis
Serous inflammation example
blister
p53 tumor suppressor gene (cancer and chromosome)
Most cancers
chromosome 17
APC tumor suppressor gene (cancer and chromosome)
Familial polyposis
Chromosome 5
BRCA-1 tumor suppressor gene (cancer and chromosome)
Breast/ovarian cancer
Chromosome 17
BRCA-2 tumor suppressor gene (cancer and chromosome)
Breast cancer
Chromosome 13
Rb tumor suppressor gene (cancer and chromosome)
Retinoblastoma
Osteosarcoma
Chromosome 13
Fragile X syndrome
SXR disease
MC genetic cause of mental retardation in males (Down’s most common overall)
Triplet repeat
Macroorchidism at puberty
Cri-du-chat
Deletion of short arm of Chr5
Mental retardation
Cry like a cat
Relation with VSD
Marfan’s syndrome
AD Fibrillin defect in elastic tissue Mitral valve prolapse w/ sudden death Aortic dissection MCC of death Dislocated lens
Brain tumors, meningioma, acoustic neuroma,
Also pheochromocytoma, cafe au lait spots, Lisch nodules (hamartomas on iris)
Neurofibromatosis (AD)
Cerebellar hemangioblastomas
Pheochromocytoma
Renal adenocarcinoma
Von Hippel Lindau (AD)
Most common teratogen
Alcohol
Oncogene relationship erb-B2/HER2
codes for a growth factor receptor
Breast cancer
Ovarian cancer
Colon cancer
Oncogene relationship ras
codes for membrane associated G proteins that transduce signals received from growth factor receptors to the phosphatidyl inostitol second messenger system.
30% of all cancer
Oncogene relationship abl
produces non-receptor proteins located on the inner cell membrane surface
Oncogene relationship t(9:22)
leads to CML
Oncogene relationship c-myc
located in the nucleus and produce protein products that activate nuclear transcription
Oncogene relationship t(8:14)
translocation leading to Burkitt’s lymphoma
Oncogene relationship N-myc
Neuroblastoma
Oncogene relationship ret
MEN IIa/IIIb
Oncogene relationship bcl-2
t(14:18)
leads to inactivation of apoptosis gene on B cells leading to immortal cell and follicular B cell lymphoma
Grade of cancer
Well differentiated if you can tell what its origin is
Poorly differentiated if you cannot tell tissue of origin
Stage of caner
T=Tumor size
N=Nodal involvement
M=Metastasis
more important than grade
Squamous, adeno, or transitional tumor nomenclature
carcinoma
mesenchymal tumor nomenclature
sarcoma
Hamartoma
non-neoplastic proliferation of cells where they belong
bronchial hamartoma, PJ polyp, hyperplastic polyp
Choristoma
non-neoplastic normal tissue where it normally isn’t (ie pancreatic tissue in stomach)
Mixed tumor
2 tissues from same cell layer (ie parotid salivary gland tumor)
Teratoma
Tissues from all cell layers
Increased AG metabolic acidosis
AG=Na-(Cl+HCO3)
(12 is normal)
adding an acid and the anion of the acid replaces the bicarb used to buffer the H+ (ie lactate, acetoacetate, B-hydroxybutyrate, phosphate/sulfate [renal failure], salicylate, formate [methanol poisoning], oxalate [ethylene glycol poisoning], acetate)
Normal AG metabolic acidosis
Losing bicarb and bicarb is replaced by an equal number of Cl anions
Acute transplant rejection
within 3 months
predominantly cellular immune reaction (type IV CD8)
Carcinogens causing transitional cell carcinoma of bladder, ureters, and renal pelvis
Aniline dyes
Benzidine
Cyclophosphamide
Phenacetin
Carcinogen causing angiosarcoma of the liver
Vinyl chloride
Carcinogen causing small cell carcinoma of the lung, squamous cancers of the oral cavity, esophagus, larynx, lung, and cervix. And Transitional carcinoma of bladder and adenocarcinoma of pancreas
Polycyclic hydrocarbons
(tobacco smoke)
Alcohol is a cocarcinogen for oral, esophageal and laryngeal cancers
Carcinogens causing lung cancerq
Chromium Uranium (radon gas)
Carcinogen causing lung and nasal cavity cancer
Nickel
Carcinogen causing nasal cavity cancer
Woodworking
Carcinogen causing angiosarcoma of liver, and hepatocellular carcinoma
Thorotrast
Carcinogen causing angiosarcoma of liver, squamous carcinoma of skin, and lung cancer
Arsenic
Carcinogen causing liver cell adenomas, hepatocellular carcinoma
Oral contraceptives
Carcinogen causing hepatocellular carcinoma
Aflatoxins
Aspergillus : cocarcinogen with HBV
Carcinogen causing prostate cancer and lung cancer
Cadmium
Carcinogen causing verrucous carcinoma in mouth
Chewing tobacco
Carcinogen causing acute leukemia and malignant lymphoma
Alkylating agents
Carcinogen causing acute leukemia
Benzene
Carcinogen causing clear cell adenocarcinoma of cervix and vagina
DES exposure in utero
Carcinogen causing Esophageal and gastric cancers
Nitrosamines
inhibited by ascorbic acid and refrigeration
Carcinogen causing squamous carcinoma of the skin (scrotum in chimney sweeps)
Tars, soots, oils
Increased in acute/chronic inflammation and monoclonal gammopathies. Best initial screen for temporal arteritis, zero in HbSS disease and polycythemias
ESR
Lymph node most common metastasis and primary tumor
MC metastasis from breast
MC primary NHL
Lung most common metastasis and primary tumor
MC metastasis from breast
MC primary adenocarcinoma
Bone most common metastasis and primary tumor
MC metastasis from breast
MC primary Multiple myeloma
Liver most common metastasis and primary tumor
MC metastasis from lung
MC primary hepatocellular carcinoma
Adrenal most common metastasis and primary tumor
MC metastasis from lung
MC primary adenocarcinoma
Brain most common metastasis and primary tumor
MC metastasis from lung
MC primary glioblastoma multiforme
Have synergistic effect on producing cancers of the oral cavity, esophagus, and larynx
Smoking + alcohol
Birth control pills protect against
Gonorrhea
not chlamydia or ovarian cancer
CO poisoning
necrosis of the globus pallidus
Parkinson’s; SaO2 decreased, PaO2 normal
L shift ODC
inhibit cytochrome oxidase
Respiratory acidosis
increase PaCO2, decrease PaO2 and SaO2
Normal PaO2 and SaO2 but decreased Hb
Anemia
Normal serum calcium/phosphate but deposits of calcium into damaged tissue, atherosclerotic plaques enzymatic fat necrosis, perivascular calcification in CMV
Dystrophic calcification
Increased serum calcium and/or phosphate with deposition of Ca in normal tissue.
Metastatic calcification
nephrocalcinosis in primary hyperparathyroidism, calcification of basal ganglia in primary hypoparathyroidism
Contain stem cells. Examples are bone marrow stem cells, stratum basalis of skin, and base of intestinal glands
Labile cells
Cells in Go phase and must be stimulated to go into G1 phase
Stable cells
Most parenchymal cells in organs, smooth muscle, and neuroglial cells
Cannot enter the cell cycle.
Permanent cells
Skeletal muscle, cardiac muscle, and neurons
Most common bone metastasized to
Vertebra
Due to Batson vertebral plexus which communicates with the vena cava