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Path Random Shit Flashcards

0
Q

What three ways does insulin resistance cause steatosis (accumulation of fat in hepatocytes)

A
  1. Impaired oxidation of fatty acids
  2. Increased synthesis and uptake of FA
  3. Decreased hepatic secretion of VLDL
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1
Q

Metabolic syndrome is defined as having at least two of what four things?

A
  1. Obesity (over 30 BMI)
  2. Insulin resistance
  3. Dyslipidemia
  4. HTN
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2
Q

Function of adiponectin

A

Anti inflammatory cytokine produced exclusively by fat cells (thank God I have a lot of it)

  • -> enhances insulin sensitivity
  • -> is reduced in metabolic syndrome
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3
Q

What 7 cancers are associated with obesity?

A
  1. Colon
  2. Breast
  3. Endometrium
  4. Esophagus
  5. Thyroid
  6. Kidney
  7. Gallbladder
  • obesity was the direct cause in up to 40% of endometrial and esophageal adenocarcinoma
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4
Q

What 5 mechanisms are thought to be the reason obesity can cause cancer?

A
  1. Increased estrogen (breast, endometrial)
  2. Increased IGF-1 (increased cell turnover and growth)
  3. Leptin (also promotes cell proliferation)
  4. mTOR (is a tumor growth regulator, fat cells direct/indirect effect)
  5. Chronic low level inflammation

*Cancers due to obesity are more fatal than average as well (20% of deaths in women and 14% in men)

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5
Q

What two symptoms result when 20-30% of Hgb is bound to CO?

A

Headache and exertional dyspnea

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6
Q

What two symptoms result when 60-70% of Hgb is bound to CO?

A

Coma and death

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7
Q

Emphysema can be thought of as resulting from what?

A

Inadequate wound repair

  • TGF beta polymorphisms can lead to reduced mesenchymal cell response to TGF beta = inadequate repair
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8
Q

What 3 cytokines are implicated in damage due to smoking?

A
  1. IL-8
  2. LTB4
  3. TNF
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9
Q

What two factors result in collapse of alveoli in emphysema?

A

Inactivation of alpha1 AT and resulting relative increase in function of neutrophil elastase

  • smoking causes inflammation and subsequent neutrophilic invasion
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10
Q

Micro path finding in respiratory bronchilitis?

A

Macrophages in the airspace; loaded with granular brown/black pigment (carman particles)–> “dusty macrophages”

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11
Q

What are Macrophages due to heart failure loaded with?

A

Hemosiderin

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12
Q

What is different about lead, mercury, arsenic, and cadmium compared to iron?

A

Only iron can be stained on H&E

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13
Q

What conditions is basophilic stippling seen in? What are they?

A

lead poisoning; megaloblastic anemia due to B12 or folate def.

Are persistent ribosomes, mature RBCs shouldn’t have any

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14
Q

What are usual, general manifestations of low-level iron toxicity?

A

CNS deficits– memory loss, hostility, hyperactivity

  • symptoms are worse in children and usually lead to outright deficits (verbal ability, hearing loss, behavior probs) due to greater BBB permeability in little dudes
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15
Q

What are three fairly common issues with high level of lead toxicity?

A
  1. Abdominal pain
  2. Arthralgias
  3. Renal insufficiency
  • on boards look for dat wrist/foot drop due to peripheral Demyelinating neuropathy. anemia is too obvious to have listed it, if you don’t know that by now, YOU FAIL
16
Q

What is elevated in the RBCs in lead poisoning?

A

Protoporphyrin–> lead inhibits the enzymes delta-aminolevulinic acid dehydratase and ferrochelatase in heme synthesis

17
Q

Mechanism of lead’s neurotoxicity?

A

Competes with Ca (both are divalent) in mitochondrial respiration; also interferes with activation of Protein kinase C (so jacks with 2nd messenger signaling). It is possible nerves also use calcium somewhat to release vesicles of NT, so lead fux with that too

18
Q

How many MIs does smoking have a role in?

A

1/3

19
Q

What are 4 ways smoke helps cause MI?

A
  1. Injure endothelial cells= increased permeability to lipids
  2. Inflammation = pro coagulant state
  3. Increase HR, BP, and MI (increased myocardial demand for blood)
  4. Carbon monoxide decreases blood oxygen-carrying capacity
20
Q

What component of smoked amuses most of the CV harm? (According to Dr. Nipples, oh, Nichols)

A

Nicotine

21
Q

3 common causes of steatosis?

A

Chronic alcohol consumption, obesity, uncontrolled DM

22
Q

3 ways EtOH causes steatosis?

A
  1. Increased NADH/NAD+ ratio due to ethanol metabolism shunts substrates away from fat breakdown to lipid biosynthesis ( enzyme for catabolism of fat need NAD+ to do their thang)
  2. Impaired assembly/secretion of lipoproteins
  3. Increased peripheral catabolism of fat
23
Q

What are two features of hepatitis?

A
  1. Acute neutrophilic inflammation
  2. Dying hepatocytes with pulmonic nuclei
  • prob some ballooning hepatocytes as well
24
Q

What 4 molecules from alcohol use cause hepatitis?

A
  1. Acetaldehyde ( induces lipid per oxidation and adduct to proteins, damaging cytoskeleton and membrane function)
  2. ROS (released from MEOS [CYP2E1], which is induced and thus more active
  3. TNF (MAIN effector of injury)
  4. Ethanol itself (cytoskeleton injury =. Mallory-Denk bodies)
25
Q

Hormone replacement therapy increases the risk of what 2 complications?

A
  1. Breast cancer

2. Thromboembolism

26
Q

Acetaminophen toxicity causes what specific kind of liver damage?

A

Centrilobular hepatic necrosis (zone3, this is closest to central vein and where CYPs are found the most)

27
Q

Cirrhosis is defined by the presence of what?

A

Regenerative nodules of hepatocytes, surrounded by fibrosis and not hooked up to hepatic arterial supply, portal venous circulation, or biliary system

28
Q

% of alcoholics that get cirrhosis? How long does it take?

A

Only 15%; usually takes around 15 years

29
Q

HepatocellulR carcinoma is the cause of death in what % of those with alcoholic liver dz?

A

3-6%

30
Q

What are 4 other complication of chronic alcohol use (one is CA, 2 are CNS)

A
  1. Breast cancer
  2. Cerebral atrophy
  3. Cerebellar degeneration
  4. Alcoholic cardiomyopathy
31
Q

Kwashiorkor is caused by what

A

Protein starvation particularly; these kids usually getting the bulk of their nutrition via carbohydrates

32
Q

What two conditions are caused by kwashiorkor?

A
  1. Edema
  2. Steatosis
  • both due to impaired protein synthesis by liver–> no lipoproteins causes accumulation of lipid in the liver; no albumin production causes edema
33
Q

What is marasmus?

A

General starvation of all nutrients in proportion–> these are the ones that look like skin and bones

34
Q

What is the principal cause of weight loss with cachexia?

A

TNF

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