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Flashcards in Nichols power points Deck (189):
1

Cherry red skin and mucous membranes

CO toxicity

2

what is the progression of signs of CO poisoning

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

3

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

4

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

5

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

6

what cancers are related to smoking

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

7

what cancer is not associated w/ smoking

prostate

8

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

hemochromatosis

9

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

hemosiderosis

10

what 4 metals are associated w/ harmful effects in humans

Pb, Hg, As, Cd

11

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

No

12

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

13

where do you see smokers macrophages

in the airspace

14

what do you call cells in a lung biopsy that are filled with what looks like iron

hemosiderin-laden macrophage (heart failure cells)

15

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

16

what would you see on a pneumococcal pneumonia sputum gram stain

G+ cocci in pairs w/ faint capsule

17

what do toxins in cigarette smoke do (7)

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

18

what do you call a RBC with black dots in it

basophilic stippling

19

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)

20

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

21

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

22

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

23

Kid comes in with abdominal pain, joint pain, constipation, and a very low IQ what does he have

high conc lead tox

24

How does low conc lead tox present in adults

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