Term
| how many deaths per year (us & world) are there from smoking? |
|
Definition
|
|
Term
| what are the 5 criteria for a cause->effect relationship? |
|
Definition
1) timing: exposure before or during development of condition
2) Strength: dose-dependent & cessation modifies condition
3) Prevalence: multiple populaitons
4) must act independently and can be synergistic
5) a possible mechanism exists: structural changes, etc. |
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|
Term
| types of smoke exposure (4) |
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Definition
| active, passive (second hand), third-hand (retention on material), fetal (in utero) |
|
|
Term
| what is the criteria for coronary disease |
|
Definition
| well established, recurrent angina pectoris and healed or recurrent acute cardiac infarct |
|
|
Term
| what is the RR for lung cancer of smokers vs non-smokers? |
|
Definition
|
|
Term
| what type of statistic do you use to assess correlation for retrospective studies? prospective? |
|
Definition
|
|
Term
| what are two infectious risk factors for suffering coronary infarct in a population of smokers? |
|
Definition
| CMV and chlamydophila pneumoniae |
|
|
Term
| name some endogenous risk factors for MI that are exacerbated by smoking: |
|
Definition
- high cholesterol
- hypertension
- high triglycerides
- obesity
- aging
- low estrogen |
|
|
Term
| why are high levels of homocysteine and iron risk factors for MI? |
|
Definition
homocysteine = breaks disulfide bridges and can cause damage to fibrin & extracellular matrix
Iron = oxidatitive damage
these risk factors are massively increased through smoking, |
|
|
Term
| what's up with diabetes and smoking |
|
Definition
| they have synergistic effect on both heart disease and diabetic progression! |
|
|
Term
|
Definition
| a biomarker for nicotine exposure |
|
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Term
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Definition
| a product of lipid peroxidation that resembles prostaglandins. does not use COX. is produced in smokers. |
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Term
| what is the stepwise process that results in the formation of foam cells, vascular smooth muscle proliferation and epithelial cell apoptosis |
|
Definition
| Smoking --> inflammation & high thiocyanate prodution --> recruitment of MPO containing cells (macrophages and neutrophils) --> OCN- production by MPO --> lysine side chains converted to homocitrulline. LDL-homocitrulline causes mentioned effects |
|
|
Term
|
Definition
| a product of lysine side chains after reaction with cyanate (produced by SCN conversion by MPO). It is a result of elevated SCN levels after smoking and increased inflammation. |
|
|
Term
| what does smoke exposure do to stress (exercise) induced angina? |
|
Definition
| decreases time to angina (ride to angina experiment) |
|
|
Term
| Name two things that smoking does to fasten the progress to emphysema? |
|
Definition
| recruitment of elastase-releasing cells (inflammation), and inactivation of alpha-anti-trypsin (elastase inhibitor). This leads to the destruction of bronchial walls and emphysema. |
|
|
Term
| what is the null alpha-anti-trypsin genetic variant's contribution to smoking-induced emphysema an example of? |
|
Definition
gene-environment interaction.
Three things go wrong with the elastase system in smokers: alveolar macrophages release chemotactic factors and enhance elastase activity, stimulates release of elastase from recruited neutrophils, and inhibits anti-alpha-trypsin |
|
|
Term
| which ethnic groups have the highest risk of smoking-induced lung cancer? lowest? middle? |
|
Definition
african americans and native hawaiians
asian and latinos
whites |
|
|
Term
these symptoms are in who and are linked to what?
Bronchitis Otitis Media
Pneumonia Middle Ear Effusion SIDS
RSV Tonsillitis Cognitive Deficits Asthma Exacerbation |
|
Definition
| children; exposure to cigarette smoke |
|
|
Term
| what about smoking causes hypoxia? |
|
Definition
| smoking induced vascular spasms, CO. CO has a higher affinity for fetal hemoglobin. |
|
|
Term
| T or F smoking increases estrogen activity |
|
Definition
| False, smoking has an anti-estrogen effect |
|
|
Term
| T or F: ulcerative colitis is has decreased incidence in smokers |
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Definition
|
|
Term
| T or F: Parkinson's disease has decreased incidence in smokers vs non-smokers |
|
Definition
|
|
Term
| T or F: smoking increases the risk of Alzheimer's disease |
|
Definition
|
|
Term
| describe the opposing effects smoking has on breast cancers before and after menarchy. |
|
Definition
start before: mutations predispose to breast cancer
start after: smoking's anti-estrogen effects decreases chance. can also cause early menopause |
|
|
Term
define:
phytotoxin
zootoxin
bacteriotoxin
toxicant
xenobiotic |
|
Definition
toxin from plants
from animals
from bacteria
man-made
synthetic antibiotic |
|
|
Term
| name some routes of toxin/cant absorption. |
|
Definition
enteral
parenteral
skin
lungs
eyes |
|
|
Term
| what does the rate of distribution for a toxin depend on? (3 things) |
|
Definition
-blood flow
-rate of transport out of capillaries into tissue/organs
-affinity for tissue |
|
|
Term
| what is a strategy to get toxins excreted faster? |
|
Definition
| increase the hydrophilicity |
|
|
Term
| name the pathways of excretion: |
|
Definition
biliary (liver)
pulmonary (lungs)
renal (urine)
skin (sweat)
gastrointestinal (feces) |
|
|
Term
|
Definition
| ability (of a toxin) to produce birth defects |
|
|
Term
|
Definition
|
|
Term
| what are the 3 things that determine the level of toxicity? |
|
Definition
|
|
Term
|
Definition
no observable effect level:
standards for food and drinking water are usually set 100 to 1000 times less than the NOEL |
|
|
Term
|
Definition
| threshold limit value: amount in ppm that produces no toxic effect with exposure time of 8hrs/day 5days/week |
|
|
Term
| name the different types of dose-response curves and an example for each |
|
Definition
- sigmoid: alcohol
- u-shaped (x^2) = vitamines/minerals
- u-shaped (-x^2) = hormones |
|
|
Term
| what is therapeutic index? |
|
Definition
LD50:ED50 in animals
TD50:ED50 in humans (10-100 is what is expected) |
|
|
Term
| define therapeutic window |
|
Definition
| range between ED50 and TD50 |
|
|
Term
| why are dogs vulnerable to theobromine? |
|
Definition
| deficiency in CYP1A2 enzyme |
|
|
Term
| 5 fluorouracil is what? what is unique about it's toxicities? |
|
Definition
chemotherapy drug used for colorectal cancer. it's a pyrimidine analog that prevents DNA replication.
It has been found to be more toxic in women than in men, mechanism is unknown, but the toxicities include gastrointestinal toxicities, mucositis, and hematologic toxicities |
|
|
Term
|
Definition
| missence polymorphism in the acetaldehyde dehydrogenase enzyme (ALDH2) |
|
|
Term
| what happens in a left-to-right cardiac shunt? |
|
Definition
|
|
Term
| what happens in a right-to-left cardiac shunt? |
|
Definition
|
|
Term
|
Definition
VSD
overriding aorta
R-ventricle hypertrophy
narrowed pulmonary artery |
|
|
Term
| what are some consequences to cardiac output obstruction? |
|
Definition
| ischemia, gangrene, infarction |
|
|
Term
| what are some consequences to cardiac output obstruction? |
|
Definition
| ischemia, gangrene, infarction |
|
|
Term
| what is wet and dry gangrene? |
|
Definition
wet = bacteria cause obstruction/ bacterial infection. sometimes black
dry = ischemia |
|
|
Term
| name the 5 causes of edema |
|
Definition
-increased hydrostatic pressure
-decreased osmotic pressure (lower protein content in blood, hypoproteinemia)
-lymphatic blockage
-sodium retention in tissue
-inflammation |
|
|
Term
| what is the decholin test? |
|
Definition
inject in median cubital vein and wait for tast on tongue. left sided heart failure will cause a delay from 14 to 24 seconds
this is a very very old way to test |
|
|
Term
| what usually causes ascites? |
|
Definition
|
|
Term
Chorea, slow progressive restriction of activities (chronic), migratory polyarthritis
These symptoms point to... |
|
Definition
|
|
Term
|
Definition
| macrophages that have phagocytosed rbcs and turned brown from the heme |
|
|
Term
| size of petechia, purpura and ecchymosis |
|
Definition
|
|
Term
| what is von willibrand factor? |
|
Definition
epithelial and plasma protein that binds factor VIII, exposed collagen after trauma, and GP1B on platelets.
deficiency causes von-willibrand's disease, a bleeding diathesis |
|
|
Term
|
Definition
| predisposition to, i.e. a bleeding diathesis |
|
|
Term
|
Definition
platelet protein. calcium dependent binding of fibrin and cause platelet agglutination/aggregation. ADP causes a conformational change that gives it affinity to fibrinogen.
deficiency causes Glanzmann thrombasthenia |
|
|
Term
|
Definition
| Bernard Soulier syndrome. GP1b binds vWF |
|
|
Term
| what is the difference between congestion and hyperemia? |
|
Definition
hyperemia = increased inflow: red, hot swollen tissues
congestion= decreased outflow: blue cyanotic tissue from blood stasis-->edema |
|
|
Term
| what do prostacyclin and nitric oxide do to platelets? |
|
Definition
impede platelet adhesion. They are produced by endothelial cells.
endothelial cells also produce adenosine diphosphatase. |
|
|
Term
|
Definition
inhibits clotting by inactivating Va and VIIIa
it is activated by thrombomodulin after it binds thrombin. |
|
|
Term
|
Definition
| tissue plasminogen activator: it cleaves plasminogen to form plasmin which degrades thrombin |
|
|
Term
| what do the heparin-like molecules do and where are they produced? |
|
Definition
they bind antithrombin III and inactivate thrombin (by binding) and Xa and IXa.
they are liberated from epithelial cells |
|
|
Term
| what are some stimuli for synthesis of tissue factor? |
|
Definition
endothelial cells synthesize tissue factor in response to cytokines (TNF or IL1) or endotoxin.
tissue factor is the intrinsic clotting stimulus, and activates X and IX to Xa and IXa |
|
|
Term
| what are in alpha granules |
|
Definition
| fibrinogen, fibronectin, factors V & VIII, platelet factor 4 (binds heparin), PDGF and TGF-beta |
|
|
Term
| what are in delta (dense) granules? |
|
Definition
| ADP, ATP, ionized clacium, histamine, serotonin and epinephrine |
|
|
Term
|
Definition
prostaglandins. PGI2 is endothelial derived vasodilator that prevents platelet aggregation.
TxA2 is a platelet derived potent vasoconstrictor that promotes platelet adhesion.
aspirin inhibits COX synthesis of both, but COX inhibition is overcome by synthesizing more COX in endothelial cells, but not in platelets |
|
|
Term
| what does plasminogen do? |
|
Definition
after activation to plasmin by tPA, uPA, factor XII or streptokinase (bacteria) breaks up fibrin clots
tPA is most active when bound to fibrin. |
|
|
Term
| what is fibrin-derived D-dimers good for? |
|
Definition
| diagnosing an excessive clotting disorder |
|
|
Term
| what causes a pleural rub? |
|
Definition
| inflammation, mostly there is a fibrin clot that abrogates the liquid lubrication |
|
|
Term
| what things can cause buildup on heart valves? |
|
Definition
| bacterial endocarditis or hypercoaguability. must look microscopically to know which one |
|
|
Term
| name the different types of shock: |
|
Definition
cardiogenic
hypovolemic
septic
neurogenic
anaphylactic |
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