Environmental Pathology

Front 1

Lab findings in an alcoholic

Back 1

fasting hypoglycemia
increased anion gap metabolic acidosis (from lactic acidosis and betahydroxybutryric acidosis)
Hyperuricemia (lactic acid and beta hydroxybutryirc acid compete with uric acid for excretion in the proximal tubules)
hypertriglyceridemia (from production of glycerol 3 phosphate)
elevated AST (etoh is a mitochondrial toxin causing AST release) and increased serum GGT (from hyperplasia of the sER)

the metabolism of EtOH produces NADH and acetyl CoA

NADH: converts pyruvate to lactace; aceteacetone to betahydroxybutyrate; and DHAP to glycerol 3 phosphate

aceyl CoA is used to synthesize fatty acids for triacylglcerides, and to synthesize ketoacids

Front 2

What is the most common complication of intravenous drug abuse?

Back 2

Hep B

Front 3

Cocaine

Back 3

Stimulant

Toxic Effects: Acute MI, CNS infarction, and perforation of the nasal septum

Clinical Signs: mydriasis, hypertension and tachycardia

Front 4

MPTP

Back 4

byproduct of the synthesis of merperidine, causing irreversible parkinson's disease; cytoxic to cells in the nigrostriatal pathway

Front 5

Drug induced aplastic anemia? hemolytic anemia?

Back 5

aplastic anemia: chloramphenicol and alkylating agents

hemolytic anemia: penicillin, methyldopa and quinidine

Front 6

What drugs induce SLE like symptoms?

Back 6

procainamide and hydralazine

Front 7

What drug side effect causes macrocytic anemia?

Back 7

methotrexate (most commonly)
phenytoin, oral contraceptives and 5-FU

Front 8

What does Aspirin Overdose look like?

Back 8

tinnitus, vertigo, change in mental status, confusion, seizures, tachypnea

acid base disorders:
respiratory alkalosis (within12-24 hours) respiratory acidosis later on

Shifts to a metabolic acidosis with an increased anion gap (more commonly in kids)

Mixed primary respiratory alkalosis with metabolic acidosis more often in adults

hyperthermia, because ASA damages the inner mitochondrial membrane, and oxidative energy is released as heat, not ATP

Front 9

What drug side effect causes thrombocytopenia?

Back 9

heparin (most commonly) followed by quinidine

Front 10

What cutaneous side effects are seen with penicillin?

Back 10

maculopapular rash and urticaria

Front 11

disorders of unopposed estrogen

Back 11

adenocarcinoma of the breast and endometrium

venous thromboembolism because estrogen decreases the synthesis of ATIII, which normally neutralizes coagulation factors

estrogen also increases the synthesis of factor I, V and VIII (take your estrogen at 8:15)

May also see intrahepatic cholestasis and jaundice, CV effects include MI and stroke

Front 12

How does estrogen promote coagulation?

Back 12

it decreases the synthesis of ATIII, which is responsible for neutralizing coagulation factors

estrogen also promotes formation of factors I, VIII, V

Front 13

What is the most commong cause of HTN in young women?

Back 13

oral contraceptives

Front 14

Oral Contraceptive Risks?

Back 14

Decreased risk for endometrial and ovarian cancer

increased risk for breast and cervical cancer

venous thromboembolism
intrahepatic cholestasis and jaundice
cholesterol gallstones, bc estrogren increases cholesterol excretion in the bile
Hypertension (due to increased synthesis of Angiotensinogen)

Front 15

what are the toxic effects associated with Mercury Poisoning?

Back 15

Diarrhea, Proximal Tubule Nephrotoxicty and constricted visual fields

Front 16

acetaminophen toxicity

Back 16

conversion to free radicals in the liver, may cause fulminant hepatitis, or renal papillary necrosis

aspirin may also cause fulminant hepatitis

Front 17

toxicity associated with rubbing alcohol

Back 17

Deep coma--> end product is acetone

Front 18

Lead toxicity

Back 18

microcytic anemia, with coarse basophilic stippling, nephrotoxicity in the proximal tubule

lead is in paint, batteries, metal casting

Front 19

methanol toxicity

Back 19

seen in washer fluid, the end product is formic acid

increased anion gap metabolic acidosis, blindness due to optic atrophy

Front 20

What does mercury poisoning cause?

Back 20

diarrhea, loss of peripheral vision, nephrotoxicity in the proximal tubules

Front 21

heat cramps

Back 21

body temp is 37, skin in moist and cool, normal mental status

Front 22

heat exhaustion

Back 22

body temp is more than 37.8 (more than 100) skin is sweaty, and they have minimally altered mental status

Front 23

Heat stroke

Back 23

Body temp is 40, skin is dry, impaired consciousness

Front 24

Which type of electical current is more dangerous, AC or DC?

Back 24

AC--> causes tetanic contractions, where DC just causes a single shock

Front 25

What is the most common cancer caused by radiation?

Back 25

acute leukemia

lymphoid tissue is most sensitive to ionizing damage

(bone is least sensitive)

Front 26

Why does Obesity lead to HTN?

Back 26

hyperinsulinemia increases sodium retention, leading to increased EABV--> LVH and stroke complicate hypertension

Front 27

What is the relationship between hyperinsulinemia and obesity, with regards to T2DM?

Back 27

High adipose levels decrease insulin receptor synthesis, leading to hyperinsulinemia (HTN), which will increase fat stores...

weight loss increases insulin receptor synthesis

Front 28

What is the function of Thiamine?

Back 28

cofactor for ATP synthesis

Chronic Alcholism is the most common cause of thiamine deficiency, and symptoms are related to decreased ATP

Dry (p. neuropathy) or Wet Beri Beri (congestive cardiomyopathy with biventricular failure)

Front 29

Wernicke's Syndrome

Back 29

mamillary body hemorrhage, ataxia, confusion, nystagmus

Front 30

Korsakoff Syndrome

Back 30

antegrade and retrograde amnesia, demyelination in the limbic system

Front 31

What generally causes death in a hanging?

Back 31

Compression of venous return, not generally compression of airflow

Front 32

What is the difference between drowing in salt water, compared to drowning in fresh water?

Back 32

salt water: because it is hypertonic, it draws in water from the capillaries, causing pulmonary edema

fresh water: aspired water is absorbed rapidly, causing hemolysis hemodilution with resting cardiac arrhythmias and heart failure

Front 33

What is the pathophysiology of heat stroke?

Back 33

core body thermoregulatory mechanisms fail

Rectal temp >106 is a grave sign
sweating ceases
generalized vasodilation with peripheral pooling
decreased circulating blood volume
myonecrosis

Front 34

At what point does loss of consciousness occur in hypothermia?

Back 34

about 90 degrees F

Front 35

What is the first pathway between stress and the immune system?

Back 35

sympathetic fibers directly innervate primary (thymus and bone marrow) and secondary lymph tissue (spleen and lymph nodes)