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MOD Exam 2 > Ch. 9 Environmental & Nutritional Disorders > Flashcards

Ch. 9 Environmental & Nutritional Disorders Flashcards

1
Q

Global Disease Burden (GDB)

A

burden of environmental, communicable, and nutritional diseases

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2
Q

Disability Adjusted Life Year (DALY)

A

years of life lost due to premature mortality & disability

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3
Q

Give examples of trends in GDB have changed in the past 20 years

A

Increased: CVD/Circulatory Dz, Cancer, HIV/AIDS Decreased: Neonatal conditions, Diarrhea Fig. 9.1- look at the width of each disease color over time

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4
Q

Organ systems affected by heatwaves and air pollution

A

Cardiovascular Respiratory Cerebrovascular

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5
Q

With increased floods and disruption of clean water supply, what diseases would be expected to increase?

A

Gastroenteritis Cholera Food/waterborne infections

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6
Q

Describe Vector-borne infectious diseases

A

Vector-borne= transmitted from one species to another Malaria, Dengue fever

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7
Q

Toxicology

A

study of distribution, effect, mechanism of action of toxic agents

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8
Q

Poison

A

STRICTLY dependent on dosage. i.e. anything can be a poison in a high enough dose

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9
Q

Xenobiotic

A

exogenous chemical absorbed by the body that provides no nutritional value. Mostly absorbed by GI, skin, lungs

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10
Q

Number one cause of global health loss?

A

Undernutrition

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11
Q

In developing countries, what diseases are the leading cause of death?

A

Infectious Disease

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12
Q

In developed countries (i.e. FAT countries) what is the leading cause of death?

A

Ischemic heart and cerebrovascular disease

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13
Q

Pathway of Xenobiotic Metabolism (very broad)

A
  1. Exposure 2. Absorption 3. a) toxicity b) storage c) excretion
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14
Q

Describe how a xenobiotic can be metabolized to be eliminated

A

Phase I reaction: increase polarity (hydrolysis, reduction, oxidation): MOVE CHARGES

Phase II reaction: add a functional group (sulfation, methylation, conjugation) Goal: Make it water soluble

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15
Q

Name the major outdoor pollutants that the EPA limits

A
  1. Sulfur Dioxide
  2. Nitrogen dioxide
  3. Ozone
  4. Lead
  5. CO
  6. Particulate Matter
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16
Q

Describe the negative effects of ground level ozone (O3)

A

Injury to respiratory tract epithelium and Type I pneumocytes.

Decreased Lung function

Increased airway reactivity

Lung inflammation

decreased exercise capacity

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17
Q

Describe the negative effects of sulfur dioxide

A

Can combine with O3 and particulate to produce Allison’s (Witches) Brew

Burning sensation in nose and throat Increased mortality and hospitalization

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18
Q

Inhalation of Particulate matter smaller than 10um can produce what symptoms

A

pulmonary inflammation (Mo and Neutrophils) 2nd cardiovascular effects

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19
Q

Describe CO poisoning

A

chronic: areas of poor ventilation

Acute: me in the garage with a hose hooked up to the exhaust after the MOD exam.

Systemic hypoxia and CNS depression Punctate Hemorrhage (Petechiae) CHERRY-RED SKIN

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20
Q

Indoor Air Pollutants

A

Wood smoke

Bioaerosals

Radon

Formaldehyde

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21
Q

Describe sick building syndrome

A

Headache, chest infection, congestion caused by poor ventilated homes and trailers

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22
Q

4 common heavy metals of environmental pollutants

A
  1. Lead
  2. Cadmium
  3. Mercury
  4. Arsenic
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23
Q

Lead Poisoning

A

binds proteins and competes with calcium metabolism. Clinical:

Lead lines on X-ray and in gums

hypochromic microcytic anemia

basophilic stippling

ring siderblasts

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24
Q
A

Basophilic Stippling

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25
Ringed Sideroblasts
26
Minamata Disease
Caused by Mercury exposure in utero Cerebral palsy, deafness, blindness, mental retardation, CNS defects
27
Arsenic
interferes with cellular metabolism GI, CV, and CNS toxicities Clinical: Neuropathy, paresthesis, hyperpigmentation, hyperkeratosis
28
Cadmium
Toxic to kidneys and lungs battery production, soil, plants Increase ROS Itai-Itai Dz
29
Itai-Itai Disease
caused by Cadmium toxicity osteoporosis and osteomalacia with renal disease
30
Toxicities that can cause Lung Cancer
Radon Asbestos Arsenic chromium uranium
31
Fibrosis of the lungs can be caused by:
Silica Asbestos Cobalt
32
7 Occupational Health Risk Hazards Discussed
1. Organic Solvents (tetrachloride and chloroform): Leukemia risk in rubber workers 2. Polycyclic Hydrocarbons: wood burning 3. Organochlorines 4. Dioxins and Polychlorinated biphenyls (PCB) 5. Mineral Dusts 6. Vinyl Chloride 7. BPA
33
Tobacco Usage
1. 90% Lung Cancers 2. Dose-dependent effects in pack years 3. 20% decreased lung cancer mortality after 5 years of smoking cessation 4. 2-4000 substances with over 60 carcinogens 5. Nicotine is addictive factor
34
What 2 substances found in cigarrettes are toxic to respiratory cilia and irritate mucosa?
Formaldehyde Nitrogen Oxides
35
Cigarrette smoking increases risk of atherosclerosis by:
Increasing platalet aggregation Inducing O2 deprivation Increased O2 need
36
3 most common diseases associated with smoking
COPD Bronchitis Emphysema
37
Alcohol abuse and related deaths
10 million chronic alcholics in US implicated in 100,000 deaths annually 50% from drunk driving, homicide, and suicide 1.8 million deaths per year worldwide
38
What is the average concentration of EtOH in the blood that is the legal definition of drunk? How many drinks is this for an average person?
80 mg/dL 3 standard drinks
39
Describe EtOH metabolism
Absorbed in the stomach Oxidized to acetaldeyde in the liver by alcohol dehydrogenase (ADH) NOT anti-diuretic hormone Competes with other CYP2E1 substrates which delays drug catabolism
40
Acute Alcoholism (Me in Austin)
CNS depression hepatic steatosis Gastritis & Ulceration
41
Chronic Alcoholism (me in 30 years)
Shortened lifespan due to liver, GI, CNS, CV & pancreas damage Thiamine (B1) deficiency= Wernicke-Korsakoff Syn Cardiomyopathy Portal HTN
42
Fetal Alcohol Syndrome
Microcephaly Growth Retardation Facial anomalies
43
Protective affects of moderate alcohol intake
Increased HDL Decreased platelet aggregation Decreased fibrinogen levels
44
Wernicke-Korsakoff Syndrome
B1 deficiency Hemorrhage and necrosis of mamillary bodies and 3/4 ventricles Clinical: Short term memory and confabulation
45
Acetaldehyde produced from EtOH metabolism final end product
Converted to acetate by acetaldehyde dehydrogenase in mitochondria and used in repiratory chain
46
A 25 year old Asian-American male presents with chief complaint that he can't drink as much as his friends Allison, Tanner, and Christian, who are all white. On PE he appears healthy and normal, no hepatomegaly or any other problems. What test would you possibly order next?
Genetic test for SNP in the ALDH2 gene that produces acetaldehyde dehydrogenase. Mutation causes reduced activity and decreased ability to oxidize acetaldehyde.
47
EtOH affect on risk of hypothermia
EtOH causes vasodilation which results in more rapid heat loss leading to hypothermia
48
Menopausal Hormone Therapy (MHT)
estrogens with progestogen to alleviate menopause symtpoms. Ok in early menopause, not long term because of increased risk of breast cancer, VTE, and PE
49
Oral Contraceptives
3-6x increased risk of VTE & PE Hepatic adenoma risk with older women and prolonged OC use
50
Acetaminophen OD
50% result in acute liver failure with a 30% mortality due to **Centrilobular Necrosis** 95% metabolized via CYPs and excreted 5% metabolized to NAPQI, which is conjugated using GSH In OD, GSH is overun and NAPQI accumulates in liver causing necrosis by damaging cellular membranes and increasing hepatocyte vulnerability to ROS
51
Aspirin OD
Respiratory Alkalosis followed my metabolic acidosis Uncoupling of Oxphos pathway that leads to lactate buildup Chronic use: headaches, dizziness, tinnitus, Vomitting, Diarrhea, **BLEEDING** via TxA2 inhibition
52
Opiates
Respiratory depression, arrhythmias, cardiac arrest, PE Right sided heart failure secondary to PE
53
Marijuana usage
Increased HR Angina Cognitive impairment (hopefully)
54
Cocaine mechanism of action
Blocks reuptake of dopamine from presynaptic vessels Blocks reuptake of NE and Epinephrine form postsynaptic vessels Basically it drives stimulation by blocking reuptake of all fun things Clinical: HTN, Tachycardia, arrhythmias, Hyperpyrexia (fever)
55
Thermal Injuries
Clinical: Depth, % of body surface **Rule of 9's** treatment: fluid & electrolyte management, infection control **Shock when \>20% of BS burned** **Sepsis** **Respiratory Insufficiency**
56
Malignant Hyperthermia
Mutation in Ryanodine Receptor 1 (RYR1) gene that causes heat-stroke like reaction to anesthetics
57
Ionizing Radiation presentation
Nuclear swelling, giant cells, pleomorphic nuclei, cytoplasmic swelling Narrowing of vascular lumen due to fibrosis
58
Describe Second Cancers caused by Ionizing Radiation
Individuals who receive radiation to treat cancer are at increased risk for developing secondary cancers such as AML Myelodysplastic Syndrome Solid Tumors
59
Morphology of radiation injury in: Lungs GI Gonads
Lungs: Edema, ARDS, Fibrosis GI Tract: Ulceration, Fibrosis Gonads: Atrophy and fibrosis
60
Describe effects of total body ionizing radiation on the brain
The brain is protected until the radiation reaches high levels (50Sv) but once reached the development time is only 1-4 hours
61
Chronic Radiation Dermatitis
Mediastinal fibrosis after radiotherapy to the thorax
62
Primary vs. Secondary dietary insufficiency
Primary: Missing from diet Secondary: malabsorption, impaired utilization, storage, excess loss
63
Secondary PEM
1. depletion of subQ fat 2. Wasting of quads and delts 3. ankle or sacral edema
64
Marasmus
\<60% of NL weight **Normal Serum Albumin** Emaciated look
65
Kwashiorkor
Decreased protein more the problem compared to decreased calories **Hypoalbuminemia** Edema, sparing of SubQ fat & muscle
66
Cachexia
PEM due to AIDs or advanced cancers Mechanism of Action: TNF and Cytokine activation of NFkB that causes muscle to be ubiquitinated and degraded by proteasomal activity
67
Anorexia Nervosa
Highest deat rate of any psychiatric DO Amenorrhea, decreased Thyroid hormone and bone density **Hypokalemia**
68
Bulimia
Binge/Purge (efficiency in my opinion) ## Footnote **Hypokalemia**
69
Vitamin A
Visual pigment Antioxidant Clinicla def: **Night Blindness**, Squamous metaplasia, Bitot Spots, Keratomalacia
70
Vitamin D
Important for Ca and Phophorus absorption Clinical Def: Rickets & Osteomalacia, Hypocalcemic Tetany Helps clear TB
71
Vitamin K
Cofactor for coagulation Clinical Def: Bleeding
72
Vitamin B1
Thiamine: coenzyme Clinical: Beriberi, Wernicke Korsakoff Beriberi: loss of appetite, weakness, pain in the limbs, shortness of breath, and swollen feet or legs.
73
Niacin
Needed for NAD used in redox reactions Clinical Def: 3 D's- Dementia, Dermatitis, Diarrhea
74
Vitamin B6
Pyridoxine Glossitis, Dermatitis, Neuropathy
75
Vitamin C
Collagen! Scurvy Hemorrhages and healing defects
76
Iron Deficiency
Inadequate Diet or Chronic Blood loss Clinical: Hypochromic Microcytic Anemia
77
BMI range categories
Normal: 18.5- 25 Overweight: 25-30 Obesity: \>30 Apple-shaped worse than Pear-shaped
78
What hormone released from adipose drives anorexogenic pathway?
Leptin Activates POMC/CART in Arcuate Nucleus and release of a-MSH
79
What 2 hormones drive orexogenic pathway
Ghrelin Release of NPY from Arcuate Nucelus that drives food intake
80
Metabolic Syndrome
intra-abdominal adiposity Insulin resistance Hyperinsulinemia HTN Decreased HDL Non-alcoholic Fatty Liver Dz Cholelithiasis
81
Describe how Obesity effects Cancer risk
Hyperinsulinemia drives IGF-1 which is a mitogen that drives the cell cycle Chronic Proinflammatory state Increased Estrogen availability

MOD Exam 2 (3 decks)

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