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Pathology > Ch10: Environmental Pathology > Flashcards

Ch10: Environmental Pathology Flashcards

1
Q

What are three major determinants of our health?

A
  1. Air we breath
  2. Food and water we consume
  3. Exposure to toxic agents
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2
Q

What is an environmental disease?

A

Condition caused by exposure to chemical or physical agents in a person’s environment

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3
Q

What is overall fatality rate of occupational injuries?

A

4.8 per 100,000 workers

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4
Q

Who set the standard for reporting health information?

A

Global Burden of Disease

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5
Q

What is the GBD statistic for assessing premature mortality and disease morbidity?

A

DALY (Disability adjusted life year)

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6
Q

What is the DALY statistic?

A

adds the years of life lost to premature mortality with the years lived with illness and disability.

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7
Q

What is said to increase due to human activity in regards to climate change?

A
  1. CO2
  2. Methane
  3. Ozone
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8
Q

Causes of increased CO2? (2)

A
  1. Combustion of hydrocarbons in automobiles and energy plants
  2. Deforestation
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9
Q

Problems with human health in regard to climate change? (4)

A
  1. CV, Cerebrovascular, Respiratory disease
  2. Gastroenteritis and infectious disease
  3. Vector-borne infectious diseases
  4. Malnutrition
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10
Q

What is the definition of poison?

A

A dose that causes harmful effects instead of helpful

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11
Q

How many pounds of carinogenic toxic chemicals are released per year in the US?

A

4 billion pounds

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12
Q

What 4 agencies determine exposure limits?

A

EPA
FDA
OSHA
CPSC

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13
Q

The EPA regulates what?

A

Exposure to peticides, toxic chemicals, water and air pollutants

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14
Q

The FDA regulates what?

A

drugs, medical devices, food additives, and

cosmetics

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15
Q

What does OSHA mandate?

A

employers provide safe working conditions for

employees

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16
Q

What does CPSC regulate?

A

other products sold for use in homes, schools, or

recreation

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17
Q

What are xenobiotics?

A

Exogenous chemicals in the air, water, food
and soil that may be absorbed into the body
through inhalation, ingestion, and skin contact

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18
Q

Where do xenobiotics act? (2)

A

Site of entry

Transported to distant tissues by BV’s

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19
Q

What xenobiotics are metabolized to form inactive water-soluble products or activated to form toxic metabolites? 2

A

Solvents

Lipophilic drugs

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20
Q

Most important catalyst of phase I reactions is what?

A

Cytochrome p450 system

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21
Q

Carbon tetrachloride is metabolized to what in the liver?

A

Toxic trichloromethyl free radical

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22
Q

Benzo-alpha-prene is metabolized to what?

A

DNA-binding metabolite carcinogen

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23
Q

Xenobiotics are typically eliminated how?

A

Phase I reaction
Phase II reaction to soluble metabolite
Eliminated from body

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24
Q

What does Radon cause?

A

Lung disease and cancer

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25
Q

EPA has limits for what 6 pollutants?

A
  1. Ozone
  2. Nitrogen oxides
  3. Sulfur dioxide
  4. Particulates
  5. CO
  6. Lead
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26
Q

Smog is what?

A

Smoke and fog

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27
Q

What leads to formation of ozone layer?

A

Interaction of UV radiation and oxygen in the stratosphere

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28
Q

Why is the ozone layer good?

A

Absorbs the most dangerous UV from sun

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29
Q

What causes ozone layer loss?

A

Halocarbons like CFP’s

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30
Q

Toxicity of ozone is due to what?

A

Production of free radicals that injury lung epithelial cells and Type I alveolar cells

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31
Q

How does ozone cause release of inflammatory mediators?

A

Oxidizes lipids to H2O2 which acts as irritant

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32
Q

Overall effect of ozone on lungs? (3)

A
  1. Increase epithelial permeability
  2. Increased reactivity of airways
  3. Decreased ciliary clearance
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33
Q

Nitrogen dioxide does what in the airway?

A

Dissolves in water to form nitric acid which damages airway epithelium

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34
Q

Sulfur dioxide is produced by who? 2

A

Power plants burning coal and oil

Byproduct of mills

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35
Q

SO2 is absorbed in airways where it releases what? (3)

Effect of this?

A

H+, HSO- (bisulfite), SO3 (sulfite)

Local irritation

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36
Q

Particulate matter like soot is most hazardous at what size?

A

Ultrafine (<10 um)

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37
Q

What is effect of ultrafine soot in lungs?

A

Phagocytosed by macrophages which causes release of inflammatory mediators that damage lungs

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38
Q

What is anthracosis?

A

Black pigment in lungs

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39
Q

3 main effects of soot in lungs?

A
  1. Cytokine release systemically
  2. Increased blood viscosity
  3. Autonomic changes affecting the heart
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40
Q

Carbon monoxide has what four characteristics?

A
  1. nonirritating
  2. colorless
  3. tasteless
  4. Odorless
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41
Q

What produces CO?

A

Incomplete oxidation of carbon materials

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42
Q

Greatest danger of CO toxicity is when?

A

Working in confined environments with high exposure (in a garage will kill in 5 minutes)

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43
Q

Carbon monoxide effects? 2

A
  1. CNS depressant

2. Binds to hemoglobin causing loss of oxygen

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44
Q

Severe hypoxia occurs when with CO?

A

20-30% saturation

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45
Q

Death and loss of consciousness occur when with CO?

A

60-70 percent saturation

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46
Q

Indoor air pollution includes? (4)

A
  1. tobacco smoke
  2. CO
  3. NO2
  4. Wood smoke (NO’s, soot, hydrocarbons)
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47
Q

Formaldehyde is found in what especially?

A

New carpet

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48
Q

Radon is a decay product of what?

A

Uranium and is found in soil

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49
Q

Asbestos fibers are found where?

A

Houses built before 1970

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50
Q

Bioareosols are used for what?

A

Aerosolization of bacteria

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51
Q

What is the famous bioaerosol exposure?

A

Legionella pneumophilia

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52
Q

Lead exposure occurs through what? 3

A

Air, food and water

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53
Q

Most absorbed lead goes where?
What does it compete with?
How is it seen radiographically?

A

Bone and teeth

Calcium

Lead lines along growth plates

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54
Q

Is acute poisoning of lead common?

A

No.

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55
Q

Acute Lead poisoning is seen with what main symptoms? 2

A

Neurologic symptoms

GI symptoms

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56
Q

Why are children affected more than adults by lead?

A
  1. Absorb 50% of ingested lead compared to adults’ 15%

2. More permeable blood brain barrier

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57
Q

Which nervous system is affected more in children?

More in adults?

A 
Children = CNS
Adults = PNS
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58
Q

How does lead present in terms of blood?

A

Microcytic anemia with coarse basophilic stippling

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59
Q

When will you see the microcytic anemia with coarse basophilic stippling in lead toxic patients?

A

At 40 ug/ml

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60
Q

Arsenic intereferes with what?

A

Cellular longevity by interfering with oxidative phosphorylation

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61
Q

Signs and symptoms of acute arsenic poisoning?

A
  1. HA
  2. Confusion
  3. Convulsion
  4. Diarrhea
  5. Vomiting
  6. Neuropathies
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62
Q

Long term exposure to arsenic leads to what?

A

Night blindness due to Vitamin A deficiency

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63
Q

3 cancers caused by long term arsenic exposure?

A
  1. Cutaneous basal cells
  2. Squamous cell
  3. Lung carcinomas
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64
Q

Cadmium is generated where? 2

A

Mining

Cadmium nickel batteries

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65
Q

Toxicities of cadmium include what? 4

A
  1. Obstructive Lung disease
  2. End stage renal disease
  3. Skeletal problems
  4. Lung carcinomas
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66
Q

Three main forms of mercurcy?

A
  1. Elemental
  2. Inorganic: Mercury chloride
  3. Organic: Methyl mercury
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67
Q

Modern sources of mercury? (4)

A
  1. Contaminated sea food
  2. Dental
  3. Gold mining
  4. industry
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68
Q

Clinical manifestation of mercury? 4

A
  1. Nervous system: CNS malfunction and peripheral neuropathies
  2. Kidney injury
  3. Tremors/bizarre behavior
  4. Gingitivitis
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69
Q

What is methyl mercury particularly toxic to?

A

Developing CNS

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70
Q

Chronic exposure of mining and industrial chromium and nickel has what effect?

A

Increased nasal and lung carcinomas

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71
Q

Cause of heart disease? (4)

A
  1. CO
  2. Lead
  3. Solvents
  4. Cadmium
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72
Q

Cause of nasal cancer? 2

A
  1. Isopropyl alcohol

2. Wood dust

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73
Q

Cause of lung cancer? 7

A
  1. Radon
  2. Asbestos
  3. Nickel
  4. Arsenic
  5. Chromium
  6. Mustard gas
  7. Uranium
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74
Q

Cause of COPD? 2

A
  1. Dust

2. Cadmium

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75
Q

Cause of respiratory irritation? 3

A
  1. ammonia
  2. sulfur oxide
  3. formaldehyde
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76
Q

Cause of fibrosis in respiratory?

A
  1. Asbestos
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77
Q

Organic solvents are readily obsorbed where? 2

A

Skin
Lungs
GI

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78
Q

Organic solvent acute exposure can lead to what?

A

CNS depression/Coma

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79
Q

Huffing involves inhalation of what?

A

Organic solvents

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80
Q

Benzene is metabolized by what?

What do its metabolites cause? (3)

A

Cytochrome p450

  1. Bone marrow toxicity
  2. Leukemia
  3. Aplastic anemia
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81
Q

Polycyclic aromatic hydrocarbons are composed of what?

A

Aromatic rings in a flat plane

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82
Q

PAH’s are found in what? 4

A

Foundries
Tars
Soot
Tobacco smoke

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83
Q

What are PAH’s considered?

A

Most potent chemical carcinogens

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84
Q

PAH’s are so potent why?

A

Very common and highly carcinogenic

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85
Q

Industrial exposure to PAH’s is linked to what? 2

A
  1. Bladder carcinoma

2. Lung carcinoma

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86
Q

Organochlorines are lipophilic products that can resist what?

A

Degradation

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87
Q

Organochlorines have what type of activity?

A

Anti-estrogenic and Anti-Androgenic leading to decreased fertility rates

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88
Q

What are most organochlorines used for?

A

Pesticides

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89
Q

Non-pesticide organochlorines are known to cause what? 4

A
  1. Chloracne
  2. CNS probs
  3. Hepatic probs
  4. Induce cytochromes
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90
Q

What is chloracne?

A

Hyperpigmentation and hyperkeratosis of face and ear

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91
Q

Vinyl chloride is used to produce what?

A

Polymer polyvinyl chloride (PVC)

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92
Q

What will vinylchloride cause?

A

Anglosarcoma of liver

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93
Q

Mineral dust inhalation causes what?

4 Examples?

A

Chronic, non-neoplastic lung disease “Pneumoconioses”

  1. Black lung
  2. Silicosis
  3. Asbestosis
  4. Berylliosis
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94
Q

What is the most preventable cause of human death?

A

Smoking tobacco

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95
Q

How many people die due to tobacco smoke in US a year?

A

440,000

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96
Q

What are the causes of death in smokers? (10)

A
  1. Lung cancer
  2. Esophageal cancer
  3. Bladder cancer
  4. Oral cavity/URT cancer
  5. Pancreatic cancer
  6. Athersclerosis
  7. CAD
  8. Emphysema
  9. COPD
  10. Respiratory infections
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97
Q

What is the number 1 cancer killer of men and women?

A

Lung cancer

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98
Q

What % of lung cancers is tobacco responsible for?

A

90%

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99
Q

Where does lung cancer rate in terms of cancer incidence in men and women?

A

2

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100
Q

What are two ways to reduce your cigarette cancer risk?

A
  1. Delay onset of smoking habits

2. Quitting

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101
Q

Is nicotine carcinogenic?

A

No, just a physical addiction

102
Q

What does nicotine do?

A

Binds to receptors in brain causing release of ACh that increases HR and BP, and contractility and output

103
Q

How are the inhaled agents of cigarette smoke harmful? (3)

A
  1. Act on mucus membranes
  2. Swallowed in saliva
  3. Absorbed in blood stream to act on distant organs
104
Q

How many components of tobacco are carcinogens?

A

60

105
Q

Tobacco smoke increases risk of atherosclerosis how?

A
  1. In addition to HT and hypercholesterolemia
  2. Increases platelet adhesion and aggregation –> Vascular thromboses –> MI’s and CVA’s
  3. Increase hypoxia –> increase arrhthmias and MI’s
106
Q

Effect of tobacco on respiratory? 2

A
  1. Allows for RT infections by destroying cilia

2. Irritation of respiratory epithelium leading to COPD

107
Q

Effect of tobacco on GI?

A

Peptic ulcer disease

108
Q

Effects of tobacco on fetus?

A
  1. Fetal hypoxia
  2. Low birth weight
  3. premature
  4. increased spontaneous abortion
  5. Complications at delivery mainly with placenta
109
Q

Effect of smoking on kids? (3)

A
  1. Infections
  2. Asthma
  3. SIDS
110
Q

Differences between tobacco chewing and smoking? 4

A
  1. Lungs spared
  2. Oral cavity irritation
  3. Increased caries, gingivitis, loss of feeth
  4. stains tooth enamel
111
Q

What are the numbers used to compare wine, beer, and liquor alcohol contents?

A

5 ounces of 24 proof wine
12 ounces of 10 proof beer
1.5 ounces of 80 proof liquor

112
Q

Can one die from acute alcohol intake?

A

Yes

113
Q

How is ethanol absorbed in GI?

A

Unaltered.

114
Q

Oxidation of ethanol in metabolism produces what?

A

Toxic agents like acetaldehyde

115
Q

How is ethanol oxidized to acetaldehyde? 3

A
  1. In peroxisome by catalase
  2. In cytosol by ADH
  3. In microsomes by CYP2E1
116
Q

How is acealdehyde converted to acetic acid?

A

ALDH in mitochondria

117
Q

What is the genetic polymorphism in alcohol dehydrogenase?

A

50% of Asians have increased activity due to point mutation so that they convert more than normal ethanol to acealdehyde leading to flushing, nausea, and tachycardia

118
Q

Who has higher levels of gastric alcohol dehydrogenase activity?
What does this mean?

A

Men

Women develop higher blood alcohol levels than men after same amount of ethanol

119
Q

Acute ethanol toxicity includes? (4)

A
  1. CNS depressant
  2. Ulceration
  3. Steatosis
  4. Acetaldehyde effects –> Esophageal and oral cancers
120
Q

Chronic ethanol toxicity includes?

A
  1. Liver (steatosis, hepatitis, cirrhosis, liver carcinoma)
  2. Nervous system: Wernicke-Korsakoff, PN’s
  3. GI tract: Ulcers, esophageal varices, malnutrition
  4. Pancreas: Pancreatitis
  5. Cardiac: cardiomyopathy, HT
  6. Cancers: Oral, esophageal, liver
  7. Pregnancy/Fetus: FAS
121
Q

What is most common cause of preventable congenital retardation in US?
Rate of it?

A

FAS (1-5 per 1000 births)

122
Q

Ethylene glycol is metabolized by what?

To produce what?

A

Alcohol dehydrogenase

Glycolic acid and oxalate

123
Q

Glycolic acid is responsible for what? 92)

A
  1. CNS probs

2. Anion gap acidosis

124
Q

Oxalate does what?

A

Binds calcium to form calcium oxalate that deposits in kidneys.

125
Q

Methanol is metabolized by what?

To form what?

A

Alcohol dehydrogenase

Formaldehyde and Formic acid

126
Q

Methanol metabolites cause what? (4)

A
  1. Ocular toxicity (blurred vision and blindness)
  2. Vomiting
  3. Dizziness
  4. Elevated anion gap acidosis
127
Q

What do you give to patients with ethylene glycol and methanol overdose? 2

A

Ethanol or fomepizole to compete for ADH enzyme spots.

Dialysis

128
Q

Elevated anion gap acidosis is do to what? 9

A 
MUDPLIERS
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde/Phenformin
Isopropyl alcohol/Isoniazid
Lactic acidosis
Ethylene glycol/Ethanol
Rhabdomyolysis
Salicylates
129
Q

How many women use hormonal contraception?

What % of reproductive women use reversible methods?

A

greater than 100 million

64%

130
Q

What population uses oral birth control pills the most?

A

Teenagers and Twentys
Never married
College degree

131
Q

Adverse effects of OBC’s include?

A
  1. Thromboembolism
  2. CV disease
  3. Liver tumors
132
Q

OBC’s thromboembolism increases DVT risk how much?

What factors increase risk? (5)

A

3 fold

Factor V mutation
Prothrombin mutation
Older than 35
Smoking
Combined estrogen/progestin OBC's
133
Q

Increased thrombotic risk in OBC’s seems due to what?

A

Acute phase response that increases CRP and coagulation factors (7, 9, 10, 12, 13) and a reduction in anticoagulants (protein S and anti-thrombin III)

134
Q

Explain OBC and CV risk? 2

A

Being older than 35

Smoker of all ages

135
Q

What type of liver tumors with OBC’s?

A

Benign hepatic adenoma

136
Q

HRT has what risks? 3

A
  1. Endometrial hyperplasia/carcinoma
  2. Increased breast carcinoma risk
  3. Venous thrombosis and PE (Especially first 2 years of use and if you have other risk factors)
137
Q

Anabolic steroids can have what effects? 7

A
  1. Stunted growth
  2. Acne, gynecomastia, and testicular atrophy in males
  3. Acne, hirsutism, and menstrual changes in females
  4. Rage
  5. CAD
  6. Hepatic cholestasis
  7. Increased prostate carcinoma
138
Q

What is the most commonly used analgesic in the US?

A

Acetaminophen

139
Q

What percentage of acute liver failure disease is acetaminophen caused?

A

Half

140
Q

At therapeutic doses what happens in metabolism of acetaminophen?

A
  1. 95% phase II detox in liver and excreted in urine

2. 5% cytochromes convert it to NAPQI which is a reactive metabolite that will harm the liver.

141
Q

What is the therapeutic window?

A

The window where the therapeutic dose doesn’t become toxic

142
Q

Acetaminophen has a small or large therapeutic window?

A

Large

143
Q

Overdoses of acetaminophen cause what?

A

GI problems and liver problems

144
Q

What type of therapy is used to reverse acetaminophen toxicity?

A

Mucomyst (acetylcysteine)

145
Q

What location in the liver has the lowest O2 concentration?

A

Around central vein

146
Q

Where does acetaminophen cause damage in the liver?

A

Around central vein

147
Q

Aspirin has what three effects?

A
  1. Irreversibly inhibits COX-1
  2. Modifies activity of COX-2
  3. Blocks production of thromboxane A2
148
Q

Acute overdose consequences of aspirin are morphologic or metabolic?

A

Metabolic

149
Q

What happens in an acute aspirin overdose?

A
  1. Respiratory alkalosis
  2. Metabolic acidosis
  3. Fatal
150
Q

Acidosis in aspirin overdose allows what?

A

Formation of non-ionized salicylates which go to brain and cause nausea/coma

151
Q

Chronic toxicity of aspirin (salicylism) involves what dose?

A

3+ grams daily for long periods

152
Q

Symptoms of aspirin chronic toxcitiy?

A
  1. Headaches and tinnitis
  2. GI problems
  3. Coma
  4. Abnormal bleeding.
  5. Neuropathy
153
Q

Aspirin and tylenol together is hard on what?

A

Renal papillae

154
Q

Crystallization of pure cocaine yields what?

A

Crack cocaine

155
Q

What does cocaine produce?

A

Euphoria and stimulation

156
Q

Does cocaine have physical dependence?

A

No, but severe psychological

157
Q

Cocaine blocks reuptake of what? (3)

A
  1. Dopamine
  2. Serotonin
  3. Catecholamines
158
Q

Cocaine also prolongs what?

And blocks what other reuptake?

A

Dopaminergic effects in brain pleasure areas

Epinephrine and norepinephrine

159
Q

Clinical clues for possible cocaine abuse?

A
  1. tachycardia/HT
  2. CAD
  3. Nasal septum problem
  4. needle tracts
  5. Seizures
160
Q

What is heroin?

A

Opioid narcotic from opium or synthesized from morphine

161
Q

What is used in treatment of heroine addiction?

Has what problem?

A

Methadone

Killing people in overdose

162
Q

IV heroin and other opiates cause what?

A
  1. CNS depression: hypoventilation (respiratory acidosis), GI issues, seizures
  2. Pulmonary injury: Edema, emboli, granulomas
  3. Infections: Skin, heart valves, liver, and lungs
163
Q

What are two main infections due to heroin?

A
  1. Staph aureus on tricuspid valve

2. Viral hepatitis

164
Q

Evidence of heroin addiction? (4)

A
  1. Narcotic abstinence syndrome
  2. Infections
  3. Renal disease: Focal segmental glomerulosclerosis
  4. Cutaneous scars, hyperpigmentation of skin over veins and thrombosed veins.
165
Q

Two types of amphetamines?

A

Methamphetamines

MDMA

166
Q

Methamphetamine acts how?

A

Releases dopamine –> Inhibits presynaptic neurotransmission at corticostriatal synapses, slowing glutamate release –> Euphoria with a crash

167
Q

How does MDMA/ecstasy work?

A

Euphoria and hallucinations due to altered serotonin levels in CNS

168
Q

Marijuana is from what?

A

Cannabis sativa plant with high levels of THC

169
Q

Marijuana has what effects?

A
  1. Distorts sensory and motor
  2. Euphoria, paranoia, bad judgment
  3. Increased appetite and dry mouth
  4. Irritant and carcinogen
170
Q

Cycad flour contains what?

A

Toxin cycasin

171
Q

How do you avoid the toxins in cycad flour?

A

Cut seeds and soak them to get the toxin out.

172
Q

Cycasin poison has what effect?

A

Degenerative neurologic disorder

173
Q

Aflatoxins are natural toxins produced by what?

A

Aspergillus?

174
Q

Where is aspergillus found?

A

In stored grains

175
Q

Aflatoxin effect on humans?

A
  1. Toxic to liver

2. Carcinogenic to liver

176
Q

Unintentional injuries/trauma rank where in deaths of adolescents and adults under 44 y/old?

A

First

177
Q

What percentage of unintentional injuries involve ethanol?

A

40%

178
Q

Motor vehicle accidents caused by what?

A
  1. Impact of vehicle on person
  2. Ejection from vehicle
  3. Trapped in vehicle
  4. Alcohol use
179
Q

What is an abrasion?

A

superficial epidermis is torn off by friction or

force

180
Q

Is there scarring in abrasion healing?

A

No, but risk of infection

181
Q

What is a laceration?

A

irregular tear in the skin produced by tissue

stretching due to blunt force

182
Q

Lacerations are typically seen how? 2

A
  1. bridging strands of fibrous tissue or
    blood vessels across the wound
  2. immediate margins are frequently hemorrhagic
    and traumatized
183
Q

Incisions are usually made by what?

A

Sharp cutting object

184
Q

Describe margins and bridging in incisions?

A

Margins = clean

No bridging

185
Q

What is a stab wound?

A

depth of wound greater than length of

wound

186
Q

What is puncture wound?

A

deep penetrating wounds made by a

long thing object such as a nail or ice pick

187
Q

What is penetration wound?

A

open wound that enters and

exists the body

188
Q

What is a gun shot wound?

A

caused by bullets or pellets fired from a gun, can be penetrating if the bullet or pellets exit the body

189
Q

What is a contusion?

A

blunt force that damages small vessels and causes extravasation of blood into tissues

190
Q

What is a superficial burn?

A

(1st degree): Confined to

epidermis

191
Q

What is a partial thickness burn?

A

(2nd degree): Injury to the
dermis (at least the deeper portions of the dermal
appendages are spared to regenerate epithelium)

192
Q

What is a full thickness burn?

A

Extends to subcutaneous
tissue (3rd degree) and may involve muscle (4th
degree)

193
Q

What is destroyed in full thickness?

A

the epidermis and dermis

and anesthesia due to nerve ending destruction

194
Q

What will cause a burn to be fatal?

A

Any burn exceeding 50% of total BSA

195
Q

What happens if burn is above 20% BSA?

A

Fluid shifts to interstitial compartments –> Hypovolemic shock

196
Q

What causes the hypovolemic shock in a burn? 2

A
  1. Increase in interstitial osmotic pressure

2. Neurogenic and mediator induced vascular permeability

197
Q

Injury to airways and lungs in thermal injury may result from what? 2

A
  1. Direct effect of heat

2. Inhalation of smoke

198
Q

What is teh most common seconday infection in thermal injury?
What other two?

A

Pseudomonas aeruginosa

Candida and s. aureus

199
Q

What causes heat cramps?
What is the hallmark
What is the mechanism?

A

Loss of electrolytes through sweating

Cramping of voluntary muscles during exercise is
the hallmark

Heat dissipating mechanisms able to maintain
normal core temp

200
Q

What is the onset of heat exhaustion?

Why does it occur?

A

Sudden collapse

failure of the cardiovascular system to
compensate for hypovolemia, secondary to water
depletion

201
Q

What is heat stroke associated with? (2)

A

High ambient temperature

High humidity

202
Q

What fails in heat stroke?

A

Thermoregulatory mechanisms fail, sweating
ceases, and core body temp rises – multi-organ
dysfunction - death

203
Q

What is the sign of heat stroke?

A

Rectal temp above 106 F

204
Q

What is the mechanism of heat stroke?

A

Mechanism is peripheral vasodilation with marked
pooling of blood and a decreased effective
circulating volume

» Necrosis of skeletal and cardiac muscle -
rhabdomyolysis

205
Q

Lowering of body temperature in systemic hypothermia is exacerbated by what? 3

A
  1. high humidity
  2. cold wet clothing
  3. alcohol
206
Q

When body gets to 90 degrees F, what happens? (3)

A
  1. loss of consciousness
  2. bradycardia
  3. atrial fib
207
Q

What do hypothermic patients do that seems strange?

A

Want to take clothes off despite freezing

208
Q

What is frostnip?

A

cooling, usually of apical structures such as

nose, cheeks and ears, from cold air exposure

209
Q

What is chilblain?

A

exposure to damp, non-freezing
temperatures that causes a vasculitis with red, raised
lesions

210
Q

What is immersion foot?

A

prolonged exposure

to wet, cool conditions

211
Q

What is frostbite?

A

Freezing of tissue

212
Q

Which is the most severe form of peripheral cold injuries?

A

Frostbite can lead to ischemia, gangrene and amputation

213
Q

Direct effects of hypothermia are mediated by what? 2

A
  1. Physical disruption of organelles within the cells

2. High salt concentrations incident to the crystallization of the intra and extracellular water

214
Q

Indirect effects of hypothermia result from what?

What do they depend on? 2

A

Circulatory changes

  1. Rate of temp drop
  2. Duration of temp drop
215
Q

Slow chilling induces what? (2)

Leading to what?

A
  1. vasoconstriction
  2. increased permeability

edema

216
Q

Rapid chilling induces what? (2)

What happens upon temperature rising?

A
  1. Vasoconstriction
  2. Ischemic injury

Increased permeability with exudation

217
Q

Electrical injury in the house can be serious when?

A

If there is low resistance like wet skin, can cause serious injury like ventricular fib

218
Q

Current from high voltage sources are more likely to produce what? (2)

A
  1. Paralysis of medullary centers

2. Extensive burns

219
Q

What are two most important variables in electrical injury?

A
  1. Resistance of tissue

2. Intensity of current

220
Q

Tissue resistance to flow varies how with water content?

A

Inversely.

Dry skin has greater resistance than wet

221
Q

Thermal effects of electrical injury depends on what?

A

intensity of current

222
Q

What is radiation?

A

energy that travels in the form of

waves or high-speed particles

223
Q

Two types of radiation?

A

Nonionizing

Ionizing

224
Q

Non-ionizing radiation is characterized by what? 3

A

longer wavelengths, lower

frequencies and lower energy

225
Q

Ionizing radiaiton can cause what?

A

Tissue heating

226
Q

typical sources of non-ionizing radiation? 2

A

sunlight

UV

227
Q

Ionizing radiation is characterized by what?

A

Shorter wavelengths
Higher frequency
Higher energy

228
Q

Ionizing radiation will disrupt what?

A

Metabolism.

229
Q

Examples of ionizing radiation? (5)

A
  1. X rays
  2. gamma rays
  3. high energy neutrons
  4. Alpha particles
  5. beta particles
230
Q

Alpha particles induce what type of damage?

What do they do poorly?

A

Heavy damage in a certain area

Penetrate poorly due to size

231
Q

3 ways to measure ionizing radiation units?

A
  1. Amount emitted by source
  2. Amount absorbed
  3. Effect of radiation
232
Q

What is a Curie?

It is an expression of what?

A

Amount of disintegration per second of a radionuclide.

Amount of radiation emitted

233
Q

What is a Gray?

A

The energy absorbed by the target tissue per unit mass

234
Q

What is a Sievert?

A

Unit of doses that depends on biologic effects of radiation

235
Q

What areas of the body are most affected by ionizing radiation? 2
Why?

A

Bone marrow and GI

Rapidly dividing

236
Q

What are the main determinants of biological effect of ionizing radiation?

A
  1. Rate of delivery
  2. Field size
  3. Cell proliferation
  4. Oxygen effects and hypoxia
  5. Vascular damage
237
Q

explain how rate of delivery impacts ionizing radiation effect?

A

Divided doses allow cells to repair some damage during exposures.

238
Q

Which recover faster to radiation, normal cells or tumor cells?

A

Normal cells

239
Q

Explain how size of field can have effect on ionizing radiation damage?

A

High doses at small shielded fields = okay

Smaller doses to larger fields = bad

240
Q

Explain how proliferation can have effect on ionizing radiation damage?

A

Damages DNA so rapidly dividing cells are vulnerable: Gonads, BM, lymph, mucosa of GI

241
Q

Cells in what cell cycle stages are most susceptible to ionizing radiation damage?

A

G2 and M

242
Q

What is the most important mechanism of radiation damage?

A

Production of ROS

243
Q

Which is more sensitive to radiation injury, well vascularized or poorly vascularized tissues?

A

Well Vascularized (more O2)

244
Q

Effect of radiation on BV’s?

A

Sclerosis which impairs function

245
Q

BV change to radiation?

A

Subintimal fibrosis with narrowing of lumen

246
Q

Skin changes to radiation?

A
  1. Atrophy of epidermis

2. Hyperkeratosis and hyper/hypopigmentation

247
Q

How long can squamous and basal cell carcinomas occur after radiation exposure?

A

20 years

248
Q

Heart changes due to radiation?

A

Fibrosis

249
Q

Lung changes due to radiation?

A

Fibrosis

250
Q

Kidney changes due to radiation? 2

A
  1. Fibrosis

2. Hyalinizatin of glomeruli

251
Q

GI, breast changes due to radiation?

A

Fibrosis

252
Q

Ovary and testis changes due to radiation?

A

Suppression of meiosis –> infertility

Pathology (36 decks)

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