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150 Cards in this Set
- Front
- Back
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Laboratory test alterations in smokers:
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1. Respiratory acidosis - air gets in but cannot get out so CO2 is retained.
2. Hypoxemia (low PaO2) - increase in PCO2 always causes a decrease in PO2 3. Decreased O, saturation - decrease in PaO2 always decreases SaO2 4. Increased carbon monoxide (CO) levels - CO is present in cigarette smoke 5. Secondary polycythemia - low PaO2 stimulates erythropoietin release & an increase in the production of RBCs 6. Absolute neutrophilic leukocytosis- metabolites in smoke mobilize the neutrophil marginating pool in the circulation by decreasing leukocyte adhesion to endothelial cells |
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Lyon's hypothesis:
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1. One of the 2 X chromosomes in a female is randomly inactivated
50% X chromosomes are maternal 50% X chromosomes are paternal Inactivated X chromosome becomes a Barr body-projection from the nucleus counted in squamous cells obtained by scrapings from the buccal mucosa 2. Normal females have 1 Barr bady & normal males do not have Barr bodies 3. Male with Klinefelter syndrome (XXY genotype) has 1 Barr body 4. Female with Turner's syndrom (XO) has no Barr bodies |
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Nondisjunction:
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Cause of the majority of chromosome number disorders (e.g. trisomy 21, Turner's XO)
Due to unequal separation of chromosomes in first phase of meiosis. |
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Mosaicism:
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Nondisjunction of chromosomes in mitotic division in the early embryonic period
Two chromosomally different cell lines are derived from a single fertilized egg Most cases involve sex chromosomes- e.g. gonadal dysgenesis with XO.XX, XO.XY |
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Translocation:
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One part of a chromosome is transferred to a non-homologous or homologous chromosome
Called a balanced translocation if the translocated fragment is functional |
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Cri-du-chat:
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Deletion of short arm of chromosome 5
Mental retardation Cry like a cat |
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Microdeletion syndromes:
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Loss of a small portion from 1 chromosome can be identified with high resolution techniques
Microdeletion on chromosome 15 may result in the Prader-Willi syndrome - chromosome 15 deletion is of paternal origin, obesity, hypogonadism, metal retardation Microdeletion of chromosome 15 may result in Angelman syndromw - chromosome 15 deletion is of maternal origin, "happy puppy" syndrome (child always happy/laughing but cannot talk) Term applied to these syndromes is genomic imprinting |
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Genetics disorders in African-Americans
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Sickle cell trait/disease - 8-10% prevalance of sickle cell gene
(x-beta-thalassemia Glucose 6-phosphate dehydrogenase (G6PD) deficiency Hereditary persistance of HgbF |
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Genetic disorders in Ashkenazi Jews
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Factor XII deficiency
Gaucher's disease Tay-Sachs disease |
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Genetic disorder in Northern Europeans
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Cystic fibrosis-MC genetic disease interfering with the patient's ability to reporduce owing to early death or problems with fertility
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Genetic disorders in Mediterranean peoples
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G6PD deficiency, sickle cell trait/disease
Beta-thalassemia |
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Genetic disorder in Southeast Asians:
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alpha-thalassemia
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MC genetic syndrome associated with advanced maternal age
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Trisomy 21
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Down syndrome pathogenesis
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Trisomy 21 - 95% of all cases, 47 chromosomes, maternal origin for extra chromosome, Robertsonian translocation- 4%, 46 chromosomes in child, mother with 45 chromosomes - usually mother,
MC genetic cause of mental ratardation- IQ 25-50 in 80% |
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Risk for future children with Down's
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1-2% overall risk for trisomy 21,
Maternal age-women >35 yrs of age. 5-15% risk for parent with a balanced translocation Karyotyep of affected child should always be determined to evaluate risk for siblings to have affected children |
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Mendelian disorders in descending order of frequency
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Autosomal dominant (AD)
Autosomal recessiver (AR) Sex-linked recessive (SXR) Sex-linked dominant (SXD) |
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Sex-linked recessive
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Examples (in order of decreasing frequency)
Fragile X syndrome G6PD deficiency Duchenne's muscular dystrophy Hemophilia A/B Severe combined immunodeficiency Wiskott-Aldrich syndrome Testicular feminization Color blindness Chronic granulomatous disease of childhood Bruton's agammaglobulinemia |
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Fragil X syndrome:
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It is a sex-linked dominant disease, owing to the fact that female carriers may express the disease in future generations (concept of anticipation)
Second MC genetic cause of mental retardation MC Mendelian disorder associated with mental retardation Clinical - mental retardation, macroorchidism - at puberty, -30% of female carriers are mentally retarded or have impaired learning - due to anticipation & addition of trinucleotide repeats with future generations, abnormal fragile X chromosome - DNA analysis for carrier identification (identify CGG trinucleotide repeat is the best test to confirm. |
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Lesch Nyhah syndrome
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SXR disease with a deficiency of hgprt - no inhibition of PRPP in purine metabolism,
Clinical - hyperuricemia, mental retardation, self mutilation |
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SXD disorders
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Percentages of children with the abnormal allele are the same as those in SXR disorders: dominant abnormal allele causes disease in both males & females, affected woman transmits symptomatic disease to 50% of her daughters & 50% of her sones, affected males transmit symptomatic disease to all of their daughters & none of their sons.
Examples: familial hypophosphatemia (defect in the proximal reabsorption of phosphate & conversion of 25(Vit D)to 1,25(Vit D), Alport sydrome (hereditary glomerulonephritis associated with nerve deafness) |
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Multifactorial (polygenic) inheritance:
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Mulitple small mutations plus the effect of environment - should be suspected when there is an increased prevalence of disease among relatives of affected individuals, parents & offspring have 50% of their genes in common
Examples, cleft lip or palete, congenital heart disease, coronary artery disease, gout, type II DM, essential hypertension, open neural defects, congenital pyloric stenosis |
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Mitochondrial DNA disorders:
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mtDNA primarily codes for enzymes involved in mitochondrial oxidative phosphorylation reactions
Ova contain mitochrondria - affected women transmit symptomatic abnormal allele to all their children Sperm lose their mitochondria during fertilization- affected males do not transmit abnormal allele to any of their children Examples: Leber's hereditary optic neuropathy, myoclonic epilepsy, lactic acid with stroke |
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Calculation of the prevalence of a genetic disease given the carrier rate:
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e.g., cystic fibrosis (CF), with a carrier rate of CF is 1/25- number of couples at risk is equal to the carrier rate in males x the carrier rate in females, or 1/25 x 1/25 = 1/625 coples are at risk, risk of having a child with CF (AR disease is 1/4, hence 1/625 x 1/4 = prevalence of --1/2500
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Deformations:
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Anatomical defects resulting from mechanical factors (extrinsic forces) that usually occur in the last two trimesters after organs have delveloped.
e.g. oligohydramnios producing facial & limb abnormatities (called Potter's facies) |
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Malformation:
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Disturbance (e.g. drugs, infection) that occurs in the morphogenesis of an organ(s)
Hypospadias faulty closure of urethral folds, Epispadias due to a defect in genital tubercle Club foot Ventricular septal defect |
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Agenesis:
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anlage (primordial tissue) is absent (e.g. renal agenesis)
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Aplasia
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anlage is present but never develops
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Hypoplasia
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anlage develops incompletely, however, the tissue that is present is histologically normal
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Mechanisms of teratogens
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Teratogens are most detrimental during the embroyonic period- first 9 wks of life (4th-5th week most sensitive for teratogens), e.g. open neural defects occur when tube normally closes between the 23rd-28th day,
Specific effects of some teratogens, some interfere with formation of mitotic spindle, interfere with production of ATP, some interfere with gene production (e.g., isotretinoin effect on Hox/hedgehog genes, which are important in embryonic patterning |
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Teratogen cocaine:
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Maternal effects, hypertension, abruptio placenta, newborn effects, hyperactivity, microcephaly (MC effect), interruption of blood flow leading to infarction (CNS, bowel, missing digits)
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Maternal diabetes mellitus & the teratogenic effects in newborns:
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Increased birthweight (macrosomia, large for gestational age): hyperinsulinism in the fetus from poor maternal glycemic control increases muscle mass (insulin increases amino acid uptake in muscle), hyperinsulinism increases fat deposition (insulin increases deposition of TG in adipose)
Open neural tub defects, Cleft lip/palate Respiratory distress syndrome: fetal hyperinsulinism in response to maternal hyperglycemia inhibits fetal surfactant production by type II pneumocytes |
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Teratogen diethylstilbestrol (DES):
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Mothers received DES to prevent threatened abortions
DES interferes with the development of mullerian structures in female fetus causing abnormalities in the tubes, uterus, cervix, upper one-third of vagina Female siblins: vabinal adenosis is the MC abnormality & is the precursor of clear cell adenocarcinoma of the vagina/cervix Cervical incompetence- increased incidence of spontaneous abortions, Uterine abnormalities- problems with implantation, Fallopian tube abnormalities- fertility problems |
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Fetal alcohol syndrome & teratogenic effects in newborns
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MC teratogen in United States 2:1000 live births
Clinical- mental retardation (MC abnormality), intrauterine growth retardation, maxillary hypoplasia, microcephaly, atrial septal defects (least common findin), hypoglycemia at birth |
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Teratogen heroin:
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Small for gestational age
Irritability/hyperactivity, High pitched cry with excessive hunger, salivation, sweating, tremors, fist sucking Temperature instability Seasures |
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Teratogen isotretinoin
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Used in treating cystic acne- must order a pregnancy test before placing a woman on the drug, patient must be on birth control pills while taking the drug
Newborn effects (3 C's): craniofacial abnormalities (small ears), micrognathia, cleft palate), cardiac defects, CNS malformations (hydrocephalus, microcephaly) |
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Teratogen phenytoin:
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Nail hypoplasia
CNS abnormalities Cleft lip/palate Congenital heart disease |
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Maternal smoking:
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Vasoconstrictive effects of nicotine produce placental ischemia- endothelial damage increases the risk for thrombosis in placental vessels,
Low birth weight babies |
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Mothers with SLE:
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SLE patients who have anti-Ro (anti-SS-A) IgG antibodies in their serum may have newborns with complete heart block
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Teratogen thalidomide:
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Previously used in the United States to control nausea associated with pregnancy- currently used in Rx of leprosy,
Limb abnormalities- amelia (absent limbs), phocomelia (seal-like limbs) |
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Teratogen valproate:
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Open neural tube defects
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Teratogen warfarin:
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Contraindicated in pregnancy: should use heparin
CNS defects Nasal hypoplasia |
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Congenital infections:
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TORCH syndrome: toxiplosmosis, Other (HBV, AIDS, parvovirus, syphilis, etc.), Rubella, CMV (cytornegaloviurs), Herpes,
Increase in IgM in cord blood, Vertical transmission (mother to fetus): transplacental MC type; blood contamination during delivery (e.g., HBV); cervical infection (HSV2, Chlamydia); breast feeding (HIV, HBV, CMV) |
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Congenital CMV:
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MC in-utero viral infection: majority are asymptomatic
Primarily transplacental, Clinical: bilateral sensorineural hearing loss MC complication; periventricular calcification; hepatosplenomegaly; chorioretinitis (may lead to blindness) Urine culture is gold standard: urine cytology reveals large, basophilic intranuclear inclusions ("owl eyes") in renal tubular cells Rx: ganciclovir (begin with this); foscarnet (if the former is not working) |
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Congenital rubella:
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Primarily transplacental: highest incidence of congenital anomalies in first 8 weeks: virus interferes with protein synthesis & produces a vasculitis
Clinical: sensorineural deafness MC complication, cataracts, patent ductus arteriosus |
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Congenital toxoplasmosis:
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Primarily transplacental
Contracted by women after exposure to cat litter: pregnant women should avoid cleaning cat litter during pregnancy, Greater risk of fetal infection later in pregnancy than earlier in pregnancy, Clinical: chorioretinitis MC late complication (often leads to blindness); calcifications in basal ganglia, Sabin Feldman dye test (uses live organisms)- "gold standard" test but is rarely performed |
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Congenital Herpes type 2:
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Primarily contracted by passing through the birth canal in women actively sheddng the virus: women actively shedding the HSV-2 virus are delivered by C-section;greater chance of fetal infection with primary rather than recurrent Herpes,
Clinical: logal or systemic disease (encephalitis, skin infections), Rx: acyclovir |
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Congenital syphilis:
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Primarily transplacental: uncommon infection during first 5 months of pregnancy; anatomical barriers prevent access to the fetal circulation,
Early neonatal syphilis (first 2 yrs): frontal bossing is MC sign, saber shins, rhagades (perioral linear scars); Hutchinson's triad: teeth (notched upper central incisors called Hutchinson's teeth & malformed molars called mulberry molars), interstitial keratitis (blindness), sensorineural hearing loss Rx: penicillin |
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Congenital Varicella-zoster virus:
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Choriretinitis-potential for blindness
Limb hypoplasia cortical atrophy in the brain vesicular skin lesions |
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AGE DEPENDENT DISORDERS:
Increased body fat |
decreases the number of insulin receptors leading to glucose intolerance
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AGE DEPENDENT DISORDERS:
Respiratory |
Obstructive type of pattern in pulmonary function tests (so-called "senile emphysema:); decreased elasticity (reduced recoil on expiration); decreased forced expiratory volume in 1 second (FEV1sec); decreased forced vital capacity (FVC); increased total lung capacity (TCL); increased residual volume (RV); low normal PaO2x
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AGE DEPENDENT DISORDERS:
Cardiovascular: |
Loss of elasticity in aorta, decreased cardiac output & heart rate in response to sress; at rest, the cardiac output is unchanged.
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AGE DEPENDENT DISORDERS:
Musculoskeletal: |
Osteoarthritus in weight bearing joints
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AGE DEPENDENT DISORDERS:
CNS |
Cerebral strophy with mild forgetfulness
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AGE DEPENDENT DISORDERS:
Sensory changes |
Cataracts; presbyopia (inability to focus on near objects); presbycusis (sensorineural hearing loss particularly at high frequency); otosclerosis (fusion of the ear ossicles producing conductive hearing loss)
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AGE DEPENDENT DISORDERS:
Immune system |
Decreased T cell function (often anergic to common skin antigens, positive PPD non-reactive or absent); loss of isohemagglutinins to blood antigens (may not develope a hemolytic transfusion reaction if blood is mismatched
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AGE DEPENDENT DISORDERS:
Skin changes |
Loss of skin elasticity (increased cross-bridging of collagin); senile purpura over the dorsum of the hands and lower legs where bumping into objects is most likely to occur; decreased sweating (eccrine glands fibrosed, danger of heat stroke)
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AGE DEPENDENT DISORDERS:
GI tract |
Decreased activity of the hepatic cytochrome P450 system (danger of drug toxicities)
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AGE DEPENDENT DISORDERS:
Male reproductive |
Prostate hyperplasia (increased urine residual volume with subsequent increase in urinary tract infections); prostate cancer (only cancer that is age dependent); decreased testosterone
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AGE DEPENDENT DISORDERS:
Female reproductive |
Breast & vulvar atrophy due to decreased estrogen; increased gonadotropins
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AGE DEPENDENT DISORDERS:
Endocrine system |
Increased glucose intolerance (due to increase in body fat & subsequent reduction in insulin receptor synthesis)
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AGE DEPENDENT DISORDERS:
Renal changes |
Decreased GFR with reduction in the creatinine clearance (risk of drug toxicity due to slow clearance of drugs)
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AGE-RELATED CHANGES
Cardiovascular |
Atherosclerosis with increased incidence of coronary artery disease, peripheral vascular disease, and storkes; temporal arteritis;
aortic stenosis (MC valvular abnormality in the elderly); systolic hypertension due to loss of aortic elasticity |
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AGE-RELATED CHANGES
Musculoskeletal system |
Osteoporosis (particularly the vertebral column in females & femoral head in males);
Paget's disease of bone |
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AGE-RELATED CHANGES
Respiratory system |
Pneumonia usually Streptococcus pneumoniae (underscores importance of Pneumovax vaccination in elderly)
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AGE-RELATED CHANGES
CNS |
Alzheimer's disease
Parkinson's disease stokes (atherosclerotic type if MC type of stroke subdural hemotomas (falls cause tearing of bridging veins in subdural space leading to a venous clot |
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AGE-RELATED CHANGES
Sensory changes |
Macular degeneration (MCC of blindness in elderly)
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AGE-RELATED CHANGES
Skin disorders |
UVB light-induced cancers
actinic (solar) keratosis (precursor of squamous cancer) |
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AGE-RELATED CHANGES
Endocrine system |
Type II diabetes mellitus
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Top 5 causes of death in males & females regardless of age & sex in the United States in descending order
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Cancer
Stroke Chronic obstructive pulmonary disease (COPD) Motor vehicle accidents- MC COD in males & females between 1-39 yrs of age. |
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Top 3 causes of death in children aged 1-14 yrs in descending order
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Accidents--50% MVAs, falls 25-30%, burns 10-15%
Cancer Congenital anomalies |
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Top 3 risk factors leading to increased morbidity/mortality in the United States in descending order
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Cigarette smoking
Dietary factors & activity patterns: high saturated fat, low fiber diet; lack of exercise Alcohol abuse |
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Gunshot wounds
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Contact wounds; contain soot & gunpowder in the wound (called fouling)
Intermediate wounds: pouder tattooing (stippling of skin around the entrance site) Distant wounds: no powder tattooing Exit wounds are larger & more irregular than entrance wounds |
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Motor vehicle accidents (MVAs)
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MCC accidental death between 1-39 yrs of age; commonly alcohal-related, particularly in teenagers
Seat belts & air bags have reduced morbidity/mortality |
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Drowning
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Common COD in children from 1-14 yrs of age
Near drowning: survival following asphyxia secondary to submersion Wet drowning: 90% of cases; initial laryngospasm on contact with water leads to) relaxation/aspiration of water Fresh/salt water drowning: whether fresh or salt water drowning, surfactant is destroyed in lungs (leads to) atelectasis with intrapulmonary shunting leads to) diffuse alveolar damage & initiates spasm in the bronchioles Immediate COD in drowning is cardiac arrhythmia |
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Burns
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First degree burns; painful partial thickness burns (e.g., sunburn); produce cell necrosis limited to the epidermis; heal without scar
Second degree burns: painful partial thickness burns; involve entire epidermis; form blisters within epidermis, heal without scarring unless they are deep Third degree burns: painless full thickness burns; extensive necrosis of epidermis/adnexa; extensive scarring complicated by keloid formation (propensity for squamous cell carcinoma); healing comes from residual epithelium at the margins of the burn & then adnexal structures COD: infection due to most commonly to Pseudomonas aeruginosa folled by Staphylococcus aureus House fires: smoke inhalation MC COD; carbon monoxide (CO) and cyanide poisoning commonly occur (source of cyanide is polyurethane in upholstery) |
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Heat Injuries
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Hyperthemia: core body temperature >37.2C
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Ultraviolet light (non-ionizing radiation)
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UVB; sunburn, corneal burns from skiing, mutagenic effect on skin
UVB-related cancers; basal cell carcinoma is MC skin cancer; squamous carcinoma (precursor is actinic/solar keratosis); malignant melanoma |
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Heat Cramps
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Afebrile; common in untrained athletes/laborers who become volume depleted; lose excess amounts of salt/water
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Heat Exhaustion
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Mild elevation in core body temperature (<39C); common in athletes training in hot/humid environment; develop severe volume depletion
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Exertional type of heat stroke:
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Core body temperatures >41C; people wrking or running on hot day; skin hot/dry; profound lactic acidosis; rhabdomyolysis common
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Non-extertional type of heat stroke
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Elderly/chronically ill patients; skin hot/dry without sweating (hypohidrosis); lactic acidosia/rhabdomyolysis uncommon
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Malignant Hyperthermia
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AD disease; defect in calcium release channels in the muscle sarcoplasmic reticulum; massive muscle contractions with extremely high temperatures after induction of anesthesia by halothane & succinylcholine (muscle relaxant)
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Treatment for patients with malignant hyperthemia
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Rx with dantrolene; screen family members with muscle biopsy & caffeine/halothane contraction test on muscle
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BURNS
First Degree |
Painful partial thickness burns (e/g/. sunburn);
Produce cell necrosis limited to the epidermis Heal without scar |
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BURNS
Second Degree |
Painful partial thickness burns
Involve entire epidermis From blisters within epidermis, heal without scarring unless they are deep |
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BURNS
Third Degree |
PAINLESS full thickness burns
Extensive necrosis of epidermis/adnexa Extensive scarring complicated by keloid formation (propensity for squamous cell carcinoma) |
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BURNS
How 3rd Degree burns heal |
Healing comes from residual epithelium at the margins of the burn & from adnexal structures
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BURNS
Cause of dz in patients with burns |
COD: infection due to most commonly to Pseudomonas aeruginosa followed by Staphylococcus aureus
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BURNS
Cause of dz in patients having been in House Fires |
Smoke inhalation MC COD
Carbon monoxide (CO) Cyanide poisoning commonly occur (source is polyurethane in upholstery) |
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Laser radiation
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intense localized heat that is equivalent to a third degree burn
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Microwave radiation
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Produces a skin burn
Adversely affect pacemaker devices inconclusive complications: cataracts, cancer, sterility |
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Infared radiation:
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Burns
Cataracts |
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High altitude
Injury |
O2 concentration is 21% (normal); decreased barametic pressure; hyperventilation in essential at high altitude since it lowers alveolar CO2 (respiratory alkalosis) --> automatically increases alveolar PAO2 -->increases arterial PO2
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High Altitude
When does acute mountain sickness occur |
Acute mountain signess occurs within the 1st 24-36 hrs of an ascent above 8000-10000 feet;
Headache, lethargy, insomnia, dyspnea |
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High Altitude
Treatment of acute mountain sickness |
RX with descent, increase fluid intake (increased insensible water loss from mucous membrane evaporation) & oxygen
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High Altitude
How to prevent acute mountain sickness |
Prevention by acclimatizing before ascending & using acetazolamide, which is a carbonic anhydrase inhibitor that produces metabolic acidosis --> compensation for the expected respiratory alkalosis
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High Altitude
What is one lung problem you can get from acute mountain sickness |
Pulmonary edema;
Non-cardiogenic |
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Smoking epidemiology
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MCC of premature death in the United States
MC single preventable cause of cancer Incidence of smoking is increasing in women & decreasing in men Nicotine intake can be monitored by measuring plasma or urine level of cotinine: continine is only dirived from the metabolism of nicotine, MOA of nicotine: absorbed rapidly into the pulmonary circulation; moves into the brain where it attaches to nicotinic cholinergic receptors to produce its gratifying effects/complication of smoking; HIGHLY ADDICTIVE AGENT Incatiovation of the p-53 suppressor gene by a point mutation on chromosome 17 is the MC genetic defect in smoking-induced cancer |
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Cancers where smoking is the leading cause:
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Lung cancer: squamous, small cell, & adenocarcinoma to a lesser extent
MCC of death due to cancer in both men & women Oral pharyngeal & laryngeal & mid-esophageal squamous cancer Pancreatic adenocarninoma Transitional cell carcinoma of bladder Renal adenocarcinoma |
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Smoking effects on the cardiovascular/CNS systems:
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Increases risk for AMI; increased risk for recurrent AMI as well
Increases risk for sudden cardiac death Increases risk for peripheral vascular disease Increases risk for strokes Contributing factors: enhanced atherosclerosis due to chemicals in smoke & nicotine effect on blood pressure & heart rate; atherogenic lipid profile; tissue hypoxia secondary to excess carbon monoxide (CO); hypercoagulability |
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Smoking effects on the respiratory system:
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COPD; -80% of all cases, chronic bronchitis, emphysema
Recurrent infections; pneumonia, URIs, Exacerbates bronchial asthma Cancer |
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Smoking effects on the GI system:
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GERD
Delays the rate of ulcer healing Increased risk for oral, upper & lower GI cancer |
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Effects of smokeless tobacco (snuff, chewing tobacco):
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Nicotine addiction, oral leukoplakia/cancer: incide the lip, under the tongue or cheek
VERRUCOUS SQUAMOUS CANCER Nasal cancer- snuff users Aggravation of cardiovascular disease: nicotine effect |
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Smoking effects on bone & menopause
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Increases the risk for osteoporosis in men & women
Biochemical reaction in women: estradiol (most potent estrogin) is normally metabolized in the liver into estrone, which is metabolized into methoxyestrone (no hormonal activity) or estriol (strong estrogen activity) --> low levels of estrogen increase the risk for osteoporosis & premature menopause |
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Passive smoking effect on children
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Pathogenesis of passive smoke effects: -75% of total combustion product in a cigarette is exhaled; risk of passive smoke extends to children as well as adults
Increases the incidence of SIDS Increases risk for lung cancer: 1-2 times increased cancer risk Exacerbates asthma Increases risk for otitis media Increases risk for recurrent upper & lower respiratory infections |
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Misc. smoking effects
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Increases risk for developing proteinuria in diabetes mellitus, directly responsible for -25% of residential fires
Vitamin C deficiency |
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Beneficial effects smoking cessationi:
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Longevity: smokers who quit before 50 years of age have half the risk of dying over the next 15 yers than a smoker has
Lung cancer: in 10 yrs, there is a 50% reduction in lung cancer when compared to a smoker, after 15 yrs, there is only a 16% risk for lung cancer when compared to a smoker AMI: AMI risk approaches that of a nonsmoker after 1 yr of abstinence Pregnancy: pregnant women who stop smoking in the first trimester reduce the risk of a low birthweight baby to that of a nonsmoker Forced expiratory volume in 1 second (FEV1 sec): it is not improved by cessation of smoking; rate of decline is similar to that of a non-smoker |
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Drugs & interstitial pulmonary fibrosis
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Amiodarone
Bleomycin Busulfan Cyclophosphamide Nitrofurantoin Nitrosourea Methysergine- also retroperitoneal fibrosis & Raynaud phenomenon Methotrexate Procarbazine |
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Automobile mechanic |
Carbon monoxide
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Pesticide industry |
Organophosphates: arsenic
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Meat Packing |
POLYVINYL CHLORIDE with risk of hepatic angiosarcoma
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Insulation/demolition/roofing matl |
Asbestos: lung cancer, mesothelioma, fibrous pleural plaques (MC overall complication of asbestos)
Formaldehyde |
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Dry Cleaning |
Carbon tetrachloride with liver necrosis due to free radicals
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Rubber/chemical Industry |
BENZENE; aplastic anemia, leukemia
ANILINE DYES; bladder cancer |
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Battery, smelter, plumber / foundry |
Lead poisoning
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Painter |
METHYLENE CHLORIDE (converted into carbon monoxide), solvents, lead
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Petroleum |
Benzene, polycyclic hydrocarbons; lung cancer
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OCCUPATIONAL EXPOSURE RELATIONSHIPS
Sewer worker |
Hydrogen sulfide gase (sulfhemoglobinermia)
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Isopropyl alcohol (rubbing alcohol) poisoning
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Metabolism: METABOLIC END-PRODUCT IN THE LIVER IS ACETONE: no metabolic acidosis unlike other alcohols; increases serum osmolai gap: difference between calculated & measured serum osmolality >10,
Clinical:deep coma with hyporeflexia |
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Methyl alcohol (Wood's alcohol)
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Increased anion gap metabolic acidosis (converted into formic acid)
Optic neuritis & potential for blindness Rx with IV ethanol; ethanol is a competitive antagonist with methyl alcohol for alcohol dehydrogenase |
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Ethylene glycol (antifeeze)
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Increased anion gap metabolic acidosis (converted into oxalic acid)
Renal failure from calcium oxalate crystals obstructing hte lumens Rx with IV ethanol: ethanol is a competitive antogonist with methyl alcohol for alcohol dehydrogenase |
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MERCURY POISONING
MOA? |
toxic in inaorganic (elemental) form
Dental amalgams, used to be used in hat making industry ("mad hatter disease"); toxic in organic form: fungicides, contaminated fish |
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MERCURY POISONING
Clinical Finding |
Diarrhea;
VISBLE ON X-RAYS NEPHROTOXIC ATN INVOLVING THE PROXIMAL TUBULES; cerebral/cerebellar neuron loss; constricted visual fields |
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MERCURY POISONING
Treatment |
Dimercaprol
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Arsenic poisoning
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Sources: pesticides, ANIMAL DIPS, Fowler's solution:
Rx of syphilis in 1930's Clinical: GARLEC ODOR TO BREATH; severe diarrhea: "rice water" stools similar to cholera; ARSENIC MELANOSIS: gray skin with dark macules; SQUAMOUS CELL CARCINOMA OF SKIN & LUNGS; nails have TRANSVERSE BANDS (Mees nails): concentrates in keratin/hair/nales; convulsions/coma: MC COD; nephrotoxic acute tubular necrosis involving proximal tubules; LIVER ANGIOSARCOMA RX: dimercaprol |
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Musroom poisoning (Amanita)
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MOA: toxin inhibits RNA polymerase
Abdominal pain/vomiting Bloody diarrhea Jaundice: extensive fatty change |
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Petroleum product (gasoline, kerosene) disorders
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Euphoria (drunk acting) when inhaled (or ingested)
Addicting Toxic doses: convulsions, tinnitus, non-cardiogenic pulmonary edema |
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Poisonous snake envenomations
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Types: PIT VIPERS: rattlesnakes (MC bite), water moccasins, copperheads; TRUE COBRAS: coral snake (NEUROTOXIN THAT BLOCKS ACETYLCHOLINE RELEASE --> paralysis & death, simlar to botulinum poison); coral snake has following color banding: "red & yellow kill a fellow" (red & yellow bands next to each other), harmless scarlet kin snake: "red & black friend of jack" (red & black bands next to each other)
Pit viper envenomations: local swelling / necrosis; hematologic problems: DIC; ANTIVENIN IS AVAILABLE: DANGER OF SERUM SICKNESS |
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Testicles in hernia sac versus hydroccle
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Testicles are not translucent
Translucency in the scotal sac implies a hydrocele |
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Visual field defect with craniopharyngioma
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bitemporal hemianopsia (impinges on optic chiasm)
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Patient with normal PT, PTT, bleeds after surgery even after receiving fresh frozen plasma and packed RBC's
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Quantitative platelet problem (thrombocytopenia) or qualitative problem (patient on NSAIDs)
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Differential diagnosis of cavitary lesions in upper lobe
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MCC is reactivation TB (not primary),
Histoplasmosis Klebsiella pneumoniae Squamous carcinoma |
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Patient with Marfan's syndrome has chest pain radiating into the back & a diastolle murmer
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aortic regugitation due to stretching of aortic valve ring by the dissection
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First step in work-up of a peripheral blood smear of microcytic anemia
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Order serum ferritin,
Decreased in iron deficiency, increased in ACD, normal in mild alpha & beta-thalassemia |
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Patient with twitching of face after tapping of facial nerve
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tetany due to decrease in ionized calcium - threshold potential is lowered so muscle/nerve are partially depolarized.
Chvostek's sign Trousscau's sign is when thumb adducts into palm when taking blood pressure |
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Patient taking penicillin for streptococcal infection develops hemolytic anemia with jaundice and a positive direct Coomb's
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Due to autoimmune hemolytic anemia (type II) against BPO attached to RBC membrane
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Main site for acetaminophen toxicity, shok, CO poisoning, alcohol in liver
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around central vein - lease amount of oxygen in this site (zone III)
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Differentiating mumps from pancreatitis
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Mumps only has increase in serum amylase
Pancreatitis has increase in amylase & lipase |
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Diffenential diagnosis of a flank mass in a child
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Wilm's tumor - associated with aniridia & hemihypertrophy in the AD type of Wilms
Renal dysplasia- MC cystic disease in children |
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Patient with viral myocarditis develops hypotension, neck vein distention, a drop in blood pressure on inspiration, & muffled heart sounds:
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Pericardial effusion from coxsackie myocarditis - Bx of heart would show a lymphocytic infiltrate with destruction of muscle
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Newborn baby girl, swelling of dorsum of hands/feet (lymphedema), cystic mass in neck
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Lymphedema in child with Turner's syndrome
XO Defects in lymphatics Cystic mass in neck due to dilated lymphatics that stretch skin & produce webbed neck |
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Smoker with painless jaundice with clay colored stools & varicosities in right upper shoulder area
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Migratory thrombophlebitis in a patient with carcinoma of the head of pancreas with obstruction of bile flow
Called Trousseau's sign |
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Patient with diarrhea & episodic flushing of the skin, nodular liver (metastasis from carcinoid tumor of terminal ileum), elevated urinary 5-hydroxyindoleacetic acid level, thick, plaque-like deposits found on the tricuspid & pulmonic valve leaflets:
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Carcinoid heart disease
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16-yr-old died suddenly while playing basketball
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hypertrophic cardiomyopathy
asymmetric hypertrophy of the interventricular septum with conduction defects murmur intensity increases (worse) with factors decreasing preload (standing, Valsalva, venodilator) Murmur intensity decreases (better) with factors increasing preload (sustained hand grip, squatting, lying down, beta-blockers |
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Hypertensive infant has masses in the skin & lytic lesions in bone; small basophilic staining cells S100 antigen positive, primary lesion in
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adrenal medulla - neuroblastoma
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Young girl with necrotic, bloody, grape-like mass protruding from the vigina; biopsy reveals malignant cells with cross-striations; tumor stains negative for cytokeratin, factor VIII related antigen, & carcinoembraonic antigen, & positive for desmin; cancer is most likely dirived from
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Muscle: embryonal rhabdomyosarcoma
MC sarcoma in children |
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Elderly woman with abdominal distention, primary cancer most likely responsible for induration in pouch of Douglas on rectal examination:
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Ovarian cancer - induration due to seeding by the cancer
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Elderly man with point tenderness in the lower vertebral column, elevated serum alkaline phosphatase. What tests or procedures would be your first step in the evaluation of this patient?
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Digital rectal exam: think cheap,
Bone tenderness implies stage IV disease & DRE should be positive Increased alkaline phosphatase suggests osteoblastic bone matastasis |
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Metastic adenocarcinoma in left supraclavicular node would most likely have its primary origin in
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Stomach adenocarcinoma with mets to Virchow's node
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15-yr old girl develops a sudden onset of right lower abdominal pain. Pregnancy test negative. Cystic mass with densities in the right ovary noted on x-ray
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Cystic teratoma
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