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Environmental Medicine > Enviro Final > Flashcards

Enviro Final Flashcards

1
Q

How can we e exposed to VOCs?

A

Ingestion
Inhalation
Dermal Absorption

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2
Q

What are the main systems affected by VOCs?

A

Hematologic, Nervous, Immune

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3
Q

Benzene toxicity can cause what pathology?

A

Leukemia due to bone marrow suppression

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4
Q

What is the component of teflon?

A

Polytetrafluorethelyne (PTFE)

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5
Q

What water soluble substance prevents access to lower respiratory tracts?

A

formaldehyde

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6
Q

The VOC is 25x more reactive that Benzene and is a commonly used “huffing” agent

A

Toluene

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7
Q

This VOC is used in dry cleaning clothes

A

Tetrachloroethylene (PERC)

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8
Q

What VOC is the precursor to medication and found in oral anesthetic agents like Carma and Chloraseptic?

A

Phenol

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9
Q

What is the most common VOC that is potentially hazardous to people working in histology labs>

A

Xylene

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10
Q

What is the source the new car smell

A

Vinyl Chloride and PVC

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11
Q

What is the main ingredient in mothballs?

A

Napthalene

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12
Q

What is the major component of tar from charred grilled foods?

A

Benzo-a-pyrene

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13
Q

What does PAH stand for?

A

Polyvinyl aromatic hydrocarbon

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14
Q

What is the most concerning pathology from Asbestos?

A

Mesothelioma

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15
Q

Which #s are the safest plastics?

A

2 and #4

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16
Q

What is used in plasticizers and are concerning due to leeching abilities?

A

Phthalates

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17
Q

What is the substance in packaging and metal can coating?

A

Bisphenol A (BPA)

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18
Q

What is the species of black mold?

A

Staphbotrys chartarum

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19
Q

What is the major sever health effect of vinyl chloride exposure from off-gasing/ leeching?

A

Hepatic Angiosarcoma

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20
Q

What are the 6 components of smog?

A 
Ground level ozone
Particulate matter
CO
NO
sulfur dioxide
lead
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21
Q

What is a xenobiotic?

A

Any substance that is foreign to the body

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22
Q

What are the 3 routes of toxin excretion?

A

Urine
Bile
Breath

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23
Q

What are 3 route of toxin absorption?

A

Ingestion
Inhalation
Dermally

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24
Q

What is the predominant CYP in the liver?

A

3A4

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25
Q

How does fasting affect biotransformation? Is fasting a good idea for biotransformation?

A

fasting is not a good idea because it requires energy that has to be spared in the fasting state at the expense of gluconeogenesis

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26
Q

What are MRLs?

A

limits set by the EPA to determine how much pesticide is in our food

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27
Q

Which heavy metal is common in organic form in shellfish and is the reason you should test someone with a weak immune system?

A

Arsenic

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28
Q

What are the 2 pollutants that form ground-level ozone?

A

NO and VOCs

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29
Q

What is the primary cause of acid rain?

A

SO2 and NO

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30
Q

What is the immune response associated with eosinophilic responses and atopy?

A

Th2

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31
Q

What are the 2 metal exposures that can lead to inability to kill candida?

A

Mercury and Lead

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32
Q

What is the main health effect of CO poisoning?

A

tissue necrosis and cell death

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33
Q

What particulate matter size is most concerning because of the ability to penetrate tissue from the blood?

A

0.1 microns

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34
Q

What form of mercury bioaccumulate in fish and is most concerning for humans?

A

methylmercury

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35
Q

What type of pesticide is DDT?

A

Organochlorine

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36
Q

Methylglobinemia is a result of exposure to what?

A

Nitrate fertilizers

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37
Q

Bioaccumulation definition:

A

accrual of toxic chemicals in tissue or a particular organism/ food chain

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38
Q

Who is the first female MD in the USA?

A

Elizabeth Blackwell

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39
Q

Sick building syndrome vs Building-related illness?

A

SBS: symptoms of illness when in a building but without specific known cause
BRI: illness from a building with an identifiable cause

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40
Q

What is the main chemical in Brazilian blow-outs?

A

Formaldehyde

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41
Q

What maternal occupation is at increase risk for cleft palate in their children?

A

preschool teachers

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42
Q

What are the components of natural gas?

A

fossil fuels, hydrocarbons

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43
Q

What are the health effects of natural gas?

A

hematologic changes with exposure to hydrogen sulfate High RBC, High HCT, HGB, PLT, LOW WBCs)

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44
Q

What exposure risk is there for a broken fluorescent bulb?

A

mercury

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45
Q

What is the common chemical in fabric softeners?

A

Phthalates

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46
Q

What is the agent added to vaccines to promote immune response?

A

Aluminum

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47
Q

What does OSHA stand for?

A

occupation safety and health administration

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48
Q

What is MSDS?

A

Material Safety Data Sheet

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49
Q

What is the 4th review?

A

study reporting the human exposure to environmental chemicals, updated regularly

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50
Q

Chemical found in forest fires, volcanoes, crude oil, exhaust and cigarettes?

A

Benzene

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51
Q

Chemical founding paint thinners, added to gasoline and adhesives?

A

Toluene

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52
Q

Chemical used in histology labs, found in coal, petroleum and wood tar

A

Xylene

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53
Q

Main effect of Xylene?

A

CNS depression

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54
Q

While volatile crystalline solid that is produced from petroleum?

A

Phenol

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55
Q

Used in plywood construction, automotive, appliance parts, a plastics precursor:

A

Phenol

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56
Q

Used adhesive glues, dyes, pressed wood, carpets, particle board:

A

Formaldehyde

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57
Q

What are health effects of Formaldehyde?

A

UPPER respiratory tract and mucus membranes symptoms

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58
Q

What is Acroosteolysis and what can cause it?

A

dissolution of terminal phalanges and SI joints0 caused by PVCs and vinyl chloride

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59
Q

From combustion of carbon-based fuels and contains multiple benzene rings:

A

PAH

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60
Q

What are the 2 forms of PAH?

A

Low molecular weight (eg. Naphthalene)

High molecular weight( eg Benzo-A-pyrene)

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61
Q

From charred grilled foods and tar:

A

PAH, specifically Benzo-A-Pyrene (HMW)

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62
Q

What is the most carcinogenic component of tobacco smoke?

A

PAH, specifically Benzo-A-pyrene (HMW)

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63
Q

What is the first carcinogen to be discovered?

A

Benzo-A-pyrene

64
Q

What is the metabolite found in 2nd and 3rd hand smoke?

A

Continine

65
Q

This is found in electrical, heat, sound, brakes, clutch and tiles:

A

Asbestos

66
Q

What are semi-safe plastic #s?

A

1 and 5

67
Q

Is polyvinyl chloride plastic safe?

A

Nope, made from #3 plastics

68
Q

Are IV tubing and bags safe?

A

Nope, made from #3 plastics (PVC)

69
Q

What are the health risks of PVC?

A

Increased CVD and Nervous diseases

70
Q

What are plasticizers?

A

Phthalates that leech easily

71
Q

What the health effects of phthalates?

A

endocrine disruption

72
Q

What are the acute exposure sxs of polystyrene?

A

mucus membrane and respiratory irritaiton

73
Q

What are the chronic exposure sxs of polystyrene?

A

N/V, fatigue, cognitive loss, neural toxicity, renal and hepatic pathologies. can affect iron absorption

74
Q

What are BPAs and where are they used?

A

Bisphenol’s found in food packaging, metal can coatings

75
Q

What are side-effects of BPAs?

A

Endocrine disruption, xenoestrogens

76
Q

What is the AQI?

A

Air Quality Index: developed by the EPA to indicate pollutant air quality

77
Q

Whats the safe size of particular matter and why?

A

PM10 microns or greater, because it cannot get deposited in the lungs

78
Q

What is the main component of haze?

A

particulate matter (PM 2.5)

79
Q

What are the 2 classes of Acetylcholinesterase?

A

Organophosphates

Carbamates

80
Q

What type of Acetylcholinesterase was used as a nerve gas in WWII?

A

Organophosphate s- banned in 1970s

81
Q

How do fertilizers affect our health?

A

Contains nitrates that alter iron in hemoglobin from ferrous state to ferris state. This then forms methemoglobin which cannot carry oxygen

82
Q

What is LD50?

A

Median lethal dose that will cause 50% death of a test group. The lower the LD50, the higher the toxicity

83
Q

What are some common mechanisms to heavy metal toxicity?

A 
enzyme inhibnition,
disruption of membranes and transport,
disruption of mitochondria, 
decreased neuronal function
binding of sulfa groups causing protein misfolding....
84
Q

Where is lead commonly found?

A

dust, soil, paint

85
Q

Who is at greatest risk of lead poisoning?

A

children, pregnant women

86
Q

Where is lead most commonly found in the environment?

A

pre 1978 homes

87
Q

What jobs have high lead exposures?

A

smelting, mining, auto repair, plumbing, military

88
Q

What hobbies have high lead exposure?

A

painting, stained glass, pottery, shooting

89
Q

What products still contain lead today?

A

computers, ceramics, pewter, jewelry, auto batteries

90
Q

What are S/Sxs of lead toxicity?

A

usu asx, decreased learning, low IQ, impaired speech, impaired hearing, body pains, fatigue, HA, tremor, weight loss, constipation, paralysis, seizures, lead lined gums

91
Q

What is the best test for lead toxicity?

A

blood

92
Q

What are acceptable BLLs for adults and children?

A

Adults: <20mcg/ dL
Children: <5 mcg/dL

93
Q

What is seen on imaging to reveal lead toxicity?

A

abdomen shows lead based items swallowed. Long bones show lead lines

94
Q

What are 3 types of mercury?

A

elemental, organic, inorganic

95
Q

What are 2 types of organic mercury?

A

methylmercury

ethylmercury

96
Q

Where is methyl mercury found?

A

fish (bioaccumulates)

97
Q

Where is ethyl mercury found?

A

preservatives, vaccines

98
Q

Where is elemental mercury found?

A

thermometers, barometers, dental amalgams, released from smelting, fossil fuels, mining

99
Q

What are health risks of mercury exposure?

A

neurotoxicity, teratogenic

100
Q

Bioaccumulation vs biomagnification

A

Bioaccumulation: substance builds up in one species
Biomagnification: eating animal that has accumulated substance

101
Q

Where is cadmium found?

A

Battery manufacturing, pigmentation, coatings, plastic stabilizers, MOSTLY FROM CIG INHALATION

102
Q

Where does cadmium accumulate?

A

Liver and Kidneys

103
Q

What are health effects of cadmium?

A

Iron deficiency, kidney damage, lung cancer

104
Q

Why is chelation of cadmium concerning?

A

it will need to be excreted through the kidneys, possibly doing further damage

105
Q

Where is arsenic found?

A

medicine, cosmetics, paint, pigments, wood preservatives

106
Q

What is the best test for acute heavy metal exposure?

A

blood

107
Q

Why is hair testing not good?

A

can have falsely high level because hair heavy metals won’t reabsorb into body and hair is exposed to dyes, shampoos, etc.
hair testing is good for methyl mercury only

108
Q

What is depuration?

A

process of free body of impurities

109
Q

What is detoxification?

A

process of making toxic substances more water soluble

110
Q

What is nasal fatigue?

A

ability to stay in an area that originally irritates the nares but , after time, the smell is no longer detected

111
Q

What are major storage sites in the body?

A

adipose tissue, bones, liver, kidney

112
Q

What are routes of excretion of chemicals?

A

urine, bile, exhalation

113
Q

what are the problems with the research surrounding xenoextrogens?

A

Mostly done on animals, and half-lives will differ in humans

114
Q

What patient population is best for stool testing?

A

children

115
Q

What are the best chelators for mercury?

A

DMPS
(DMSA is best for lead, then mercury)
(EDTA is mostly used for lead, although it does have greater affinity for mercury)

116
Q

What administration method is best for chelation?

A

IV

117
Q

Why avoid seafood 7 days before challenge testing?

A

to prevent falsely elevated arsenic or mercury

118
Q

What is the best method for acetylcholinesterase testing?

A

whole blood and plasma

119
Q

What is the theory behind hydrotherapy for treatment of heavy metals?

A

increased bile dumping?

120
Q

Why is low temperature sauna beneficial for detoxification?

A

increases lipolysis and can increase excreting of heavy metals stored in adipose tissue

121
Q

What supplements increase glutathione production?

A

(glutathione is not well absorbed orally)
NAC 1500-1800 mg/day
L-cystein

122
Q

What are the most supportive supplements for heavy metal exposure (and dosages!)

A

C: 6-12 g/day (ROS scavenger)
Fiber (helps bind bile)
Selenium 2 mcg/day (increases metal excretion and phase 2 detox)
Zinc: 30mg BID-TID (give copper too) (mercury depletes zinc)

123
Q

What are the diagnostic criteria for MCS?

A
  1. Sxs reproducible with repeated chemical exposures
  2. condition has persisted for significant time
  3. low levels of exposure results in manifestations of syndrome (i.e. increased sensitivity)
  4. Sxs improve when the triggering chemicals are removed
  5. responses often occur to multiple chemically unrelated substances
  6. Sxs involve multiple organ systems
124
Q

This chemical can penetrate most clothing

A

Xylene

125
Q

What is found in pipes, insulation, siding and shower curtains?

A

PVC, Vinyl Chloride

126
Q

What is HCA?

A

Heterocyclic amines (from grilling foods) (from HMW benzo-a-pyrene)

127
Q

What are some prevention strategies to protect against PAHs?

A

stop smoking, limit grilled meats
increase brassicas
increase antioxidants
marinade in acids

128
Q

what plastic # is transvaginal mesh and diapers?

A

5

129
Q

What are the minor sources of air pollution?

A

nail salons, dry cleaners, auto and body shops

130
Q

What are CFCs and what are their common use?

A

Chlorofluorocarbons and found in refrigerants, solvents and foam blowing agents

131
Q

What soil pesticide was removed due to its biomagnification effects?

A

organochlorines (DDT)

132
Q

How does mercury get through the BB?

A

its not fat soluble, transported by ending to sulfhydryl groups on cysteines

133
Q

What is NAC use controversial in detox?

A

cysteine increase means more can get through the BB because methymercury binds to it to pass through the BBB

134
Q

lead poisoning results on CBC:

A

microcytic hypochromic anemia with basophilic stippling

135
Q

Reference range for whole blood mercury:

A

<5ug/L

136
Q

What has increased absorption when there is iron deficiency?

A

Cadmium

137
Q

How does cadmium contribute to osteomalacia/osteoporosis?

A

increased urinary excretion of calcium and phosphorous and decreased hydroxylation of Vit D metabolites

138
Q

Where is arsenic absorbed in the body?

A

GI tract (small intestine)

139
Q

What is biotransformation?

A

conversion of lipid soluble xenoestrogen into water soluble substance for excretion

140
Q

What are some inhibitors?

A

heavy metals, trauma, obesity

141
Q

circadian clock of glutathione production?

A

6pm GSH cycles between oxidation and cycled back to glutathione by glutathione reductase. If a heavy metal is present, then replenishment cannot occur, leading to GSH deficiency

142
Q

Th1 vs Th2 cytokines:

A

Th1: IL-2, IFNg, M0 activity
Th2: IL-4, IL-5, IL-10

143
Q

DS, Dioxin, DDT can cause atrophy of what glandular cells?

A

thymus

144
Q

PCB exposure may make people prone to what?

A

increased allergic response

145
Q

PAH exposure has decreased activity in what organs?

A

spleen and thymus

146
Q

lead and mercury decrease ability to kill….

A

candida

147
Q

What supplementation can be protective of immune function with cadmium exposure?

A

selenium

148
Q

What is the main toxin causing concerns with reproductive problems in offspring?

A

DES

149
Q

Half-life of genistein and daidzein (soy)

A

5-6 hours

150
Q

what toxin affects the thyroid?

A

PCBs- bind thyroxine

151
Q

What tests must you do before doing any specialty testing?

A

CBC, CMP, Lipids, complete UA, HCG, G6PD, TB

152
Q

most accurate test for body burden of heavy metals:

A

none exists

153
Q

What is DMPS best for, IV or oral and common SEs?

A

Mercury
IV best, oral is available
SEs: feeling happy, exhausted, N, dizzy, rash
dose: 3-5 mg/Kg body weight

154
Q

what is DMSA best for? best route and SE?

A 
lead
Oral best (20-30mg/kg body weight on empty stomach)

SE: GI dysfxn, rash, DEF of essential elements, mood changes

155
Q

What is EDTA best for? best route and SE?

A

lead (even though mercury is high affinity)
IV best (50mg/kg body weight)
SE: hypotension, hypoglycemia, hypocalcemia

Environmental Medicine (1 decks)

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