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150 Cards in this Set

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Laboratory test alterations in smokers:
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
Lyon's hypothesis:
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
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.
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
One part of a chromosome is transferred to a non-homologous or homologous chromosome
Called a balanced translocation if the translocated fragment is functional
Deletion of short arm of chromosome 5
Mental retardation
Cry like a cat
Microdeletion syndromes:
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
Genetics disorders in African-Americans
Sickle cell trait/disease - 8-10% prevalance of sickle cell gene
Glucose 6-phosphate dehydrogenase (G6PD) deficiency
Hereditary persistance of HgbF
Genetic disorders in Ashkenazi Jews
Factor XII deficiency
Gaucher's disease
Tay-Sachs disease
Genetic disorder in Northern Europeans
Cystic fibrosis-MC genetic disease interfering with the patient's ability to reporduce owing to early death or problems with fertility
Genetic disorders in Mediterranean peoples
G6PD deficiency, sickle cell trait/disease
Genetic disorder in Southeast Asians:
MC genetic syndrome associated with advanced maternal age
Trisomy 21
Down syndrome pathogenesis
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%
Risk for future children with Down's
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
Mendelian disorders in descending order of frequency
Autosomal dominant (AD)
Autosomal recessiver (AR)
Sex-linked recessive (SXR)
Sex-linked dominant (SXD)
Sex-linked recessive
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
Fragil X syndrome:
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.
Lesch Nyhah syndrome
SXR disease with a deficiency of hgprt - no inhibition of PRPP in purine metabolism,
Clinical - hyperuricemia, mental retardation, self mutilation
SXD disorders
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)
Multifactorial (polygenic) inheritance:
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
Mitochondrial DNA disorders:
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
Calculation of the prevalence of a genetic disease given the carrier rate:
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
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)
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
anlage (primordial tissue) is absent (e.g. renal agenesis)
anlage is present but never develops
anlage develops incompletely, however, the tissue that is present is histologically normal
Mechanisms of teratogens
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
Teratogen cocaine:
Maternal effects, hypertension, abruptio placenta, newborn effects, hyperactivity, microcephaly (MC effect), interruption of blood flow leading to infarction (CNS, bowel, missing digits)
Maternal diabetes mellitus & the teratogenic effects in newborns:
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
Teratogen diethylstilbestrol (DES):
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
Fetal alcohol syndrome & teratogenic effects in newborns
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
Teratogen heroin:
Small for gestational age
High pitched cry with excessive hunger, salivation, sweating, tremors, fist sucking
Temperature instability
Teratogen isotretinoin
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)
Teratogen phenytoin:
Nail hypoplasia
CNS abnormalities
Cleft lip/palate
Congenital heart disease
Maternal smoking:
Vasoconstrictive effects of nicotine produce placental ischemia- endothelial damage increases the risk for thrombosis in placental vessels,
Low birth weight babies
Mothers with SLE:
SLE patients who have anti-Ro (anti-SS-A) IgG antibodies in their serum may have newborns with complete heart block
Teratogen thalidomide:
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)
Teratogen valproate:
Open neural tube defects
Teratogen warfarin:
Contraindicated in pregnancy: should use heparin
CNS defects
Nasal hypoplasia
Congenital infections:
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)
Congenital CMV:
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)
Congenital rubella:
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
Congenital toxoplasmosis:
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
Congenital Herpes type 2:
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
Congenital syphilis:
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
Congenital Varicella-zoster virus:
Choriretinitis-potential for blindness
Limb hypoplasia cortical atrophy in the brain
vesicular skin lesions

Increased body fat
decreases the number of insulin receptors leading to glucose intolerance

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

Loss of elasticity in aorta, decreased cardiac output & heart rate in response to sress; at rest, the cardiac output is unchanged.

Osteoarthritus in weight bearing joints

Cerebral strophy with mild forgetfulness

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)

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

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)

GI tract
Decreased activity of the hepatic cytochrome P450 system (danger of drug toxicities)

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

Female reproductive
Breast & vulvar atrophy due to decreased estrogen; increased gonadotropins

Endocrine system
Increased glucose intolerance (due to increase in body fat & subsequent reduction in insulin receptor synthesis)

Renal changes
Decreased GFR with reduction in the creatinine clearance (risk of drug toxicity due to slow clearance of drugs)

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

Musculoskeletal system
Osteoporosis (particularly the vertebral column in females & femoral head in males);
Paget's disease of bone

Respiratory system
Pneumonia usually Streptococcus pneumoniae (underscores importance of Pneumovax vaccination in elderly)

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

Sensory changes
Macular degeneration (MCC of blindness in elderly)

Skin disorders
UVB light-induced cancers
actinic (solar) keratosis (precursor of squamous cancer)

Endocrine system
Type II diabetes mellitus
Top 5 causes of death in males & females regardless of age & sex in the United States in descending order
Chronic obstructive pulmonary disease (COPD)
Motor vehicle accidents- MC COD in males & females between 1-39 yrs of age.
Top 3 causes of death in children aged 1-14 yrs in descending order
Accidents--50% MVAs, falls 25-30%, burns 10-15%
Congenital anomalies
Top 3 risk factors leading to increased morbidity/mortality in the United States in descending order
Cigarette smoking
Dietary factors & activity patterns: high saturated fat, low fiber diet; lack of exercise
Alcohol abuse
Gunshot wounds
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
Motor vehicle accidents (MVAs)
MCC accidental death between 1-39 yrs of age; commonly alcohal-related, particularly in teenagers
Seat belts & air bags have reduced morbidity/mortality
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
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)
Heat Injuries
Hyperthemia: core body temperature >37.2C
Ultraviolet light (non-ionizing radiation)
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
Heat Cramps
Afebrile; common in untrained athletes/laborers who become volume depleted; lose excess amounts of salt/water
Heat Exhaustion
Mild elevation in core body temperature (<39C); common in athletes training in hot/humid environment; develop severe volume depletion
Exertional type of heat stroke:
Core body temperatures >41C; people wrking or running on hot day; skin hot/dry; profound lactic acidosis; rhabdomyolysis common
Non-extertional type of heat stroke
Elderly/chronically ill patients; skin hot/dry without sweating (hypohidrosis); lactic acidosia/rhabdomyolysis uncommon
Malignant Hyperthermia
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)
Treatment for patients with malignant hyperthemia
Rx with dantrolene; screen family members with muscle biopsy & caffeine/halothane contraction test on muscle

First Degree
Painful partial thickness burns (e/g/. sunburn);
Produce cell necrosis limited to the epidermis
Heal without scar

Second Degree
Painful partial thickness burns
Involve entire epidermis
From blisters within epidermis, heal without scarring unless they are deep

Third Degree
PAINLESS full thickness burns
Extensive necrosis of epidermis/adnexa
Extensive scarring complicated by keloid formation (propensity for squamous cell carcinoma)

How 3rd Degree burns heal
Healing comes from residual epithelium at the margins of the burn & from adnexal structures

Cause of dz in patients with burns
COD: infection due to most commonly to Pseudomonas aeruginosa followed by Staphylococcus aureus

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)
Laser radiation
intense localized heat that is equivalent to a third degree burn
Microwave radiation
Produces a skin burn
Adversely affect pacemaker devices
inconclusive complications: cataracts, cancer, sterility
Infared radiation:
High altitude

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
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
High Altitude

Treatment of acute mountain sickness
RX with descent, increase fluid intake (increased insensible water loss from mucous membrane evaporation) & oxygen
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
High Altitude

What is one lung problem you can get from acute mountain sickness
Pulmonary edema;
Smoking epidemiology
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
Cancers where smoking is the leading cause:
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
Smoking effects on the cardiovascular/CNS systems:
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
Smoking effects on the respiratory system:
COPD; -80% of all cases, chronic bronchitis, emphysema
Recurrent infections; pneumonia, URIs,
Exacerbates bronchial asthma
Smoking effects on the GI system:
Delays the rate of ulcer healing
Increased risk for oral, upper & lower GI cancer
Effects of smokeless tobacco (snuff, chewing tobacco):
Nicotine addiction, oral leukoplakia/cancer: incide the lip, under the tongue or cheek
Nasal cancer- snuff users
Aggravation of cardiovascular disease: nicotine effect
Smoking effects on bone & menopause
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
Passive smoking effect on children
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
Misc. smoking effects
Increases risk for developing proteinuria in diabetes mellitus, directly responsible for -25% of residential fires
Vitamin C deficiency
Beneficial effects smoking cessationi:
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
Drugs & interstitial pulmonary fibrosis
Methysergine- also retroperitoneal fibrosis & Raynaud phenomenon

Automobile mechanic
Carbon monoxide

Pesticide industry
Organophosphates: arsenic

Meat Packing
POLYVINYL CHLORIDE with risk of hepatic angiosarcoma
Insulation/demolition/roofing matl
Asbestos: lung cancer, mesothelioma, fibrous pleural plaques (MC overall complication of asbestos)

Dry Cleaning
Carbon tetrachloride with liver necrosis due to free radicals
Rubber/chemical Industry
BENZENE; aplastic anemia, leukemia
ANILINE DYES; bladder cancer
Battery, smelter, plumber / foundry
Lead poisoning
METHYLENE CHLORIDE (converted into carbon monoxide), solvents, lead
Benzene, polycyclic hydrocarbons; lung cancer
Sewer worker
Hydrogen sulfide gase (sulfhemoglobinermia)
Isopropyl alcohol (rubbing alcohol) poisoning
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
Methyl alcohol (Wood's alcohol)
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
Ethylene glycol (antifeeze)
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

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
Clinical Finding
NEPHROTOXIC ATN INVOLVING THE PROXIMAL TUBULES; cerebral/cerebellar neuron loss; constricted visual fields
Arsenic poisoning
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
Musroom poisoning (Amanita)
MOA: toxin inhibits RNA polymerase
Abdominal pain/vomiting
Bloody diarrhea
Jaundice: extensive fatty change
Petroleum product (gasoline, kerosene) disorders
Euphoria (drunk acting) when inhaled (or ingested)
Toxic doses: convulsions, tinnitus, non-cardiogenic pulmonary edema
Poisonous snake envenomations
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
Testicles in hernia sac versus hydroccle
Testicles are not translucent
Translucency in the scotal sac implies a hydrocele
Visual field defect with craniopharyngioma
bitemporal hemianopsia (impinges on optic chiasm)
Patient with normal PT, PTT, bleeds after surgery even after receiving fresh frozen plasma and packed RBC's
Quantitative platelet problem (thrombocytopenia) or qualitative problem (patient on NSAIDs)
Differential diagnosis of cavitary lesions in upper lobe
MCC is reactivation TB (not primary),
Klebsiella pneumoniae
Squamous carcinoma
Patient with Marfan's syndrome has chest pain radiating into the back & a diastolle murmer
aortic regugitation due to stretching of aortic valve ring by the dissection
First step in work-up of a peripheral blood smear of microcytic anemia
Order serum ferritin,
Decreased in iron deficiency, increased in ACD, normal in mild alpha & beta-thalassemia
Patient with twitching of face after tapping of facial nerve
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
Patient taking penicillin for streptococcal infection develops hemolytic anemia with jaundice and a positive direct Coomb's
Due to autoimmune hemolytic anemia (type II) against BPO attached to RBC membrane
Main site for acetaminophen toxicity, shok, CO poisoning, alcohol in liver
around central vein - lease amount of oxygen in this site (zone III)
Differentiating mumps from pancreatitis
Mumps only has increase in serum amylase
Pancreatitis has increase in amylase & lipase
Diffenential diagnosis of a flank mass in a child
Wilm's tumor - associated with aniridia & hemihypertrophy in the AD type of Wilms
Renal dysplasia- MC cystic disease in children
Patient with viral myocarditis develops hypotension, neck vein distention, a drop in blood pressure on inspiration, & muffled heart sounds:
Pericardial effusion from coxsackie myocarditis - Bx of heart would show a lymphocytic infiltrate with destruction of muscle
Newborn baby girl, swelling of dorsum of hands/feet (lymphedema), cystic mass in neck
Lymphedema in child with Turner's syndrome
Defects in lymphatics
Cystic mass in neck due to dilated lymphatics that stretch skin & produce webbed neck
Smoker with painless jaundice with clay colored stools & varicosities in right upper shoulder area
Migratory thrombophlebitis in a patient with carcinoma of the head of pancreas with obstruction of bile flow
Called Trousseau's sign
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:
Carcinoid heart disease
16-yr-old died suddenly while playing basketball
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
Hypertensive infant has masses in the skin & lytic lesions in bone; small basophilic staining cells S100 antigen positive, primary lesion in
adrenal medulla - neuroblastoma
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
Muscle: embryonal rhabdomyosarcoma
MC sarcoma in children
Elderly woman with abdominal distention, primary cancer most likely responsible for induration in pouch of Douglas on rectal examination:
Ovarian cancer - induration due to seeding by the cancer
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?
Digital rectal exam: think cheap,
Bone tenderness implies stage IV disease & DRE should be positive
Increased alkaline phosphatase suggests osteoblastic bone matastasis
Metastic adenocarcinoma in left supraclavicular node would most likely have its primary origin in
Stomach adenocarcinoma with mets to Virchow's node
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
Cystic teratoma