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MOD Midterm > Enviromental Diseases Pt2 > Flashcards

Enviromental Diseases Pt2 Flashcards

1
Q

What are organic solvents and what can acute exposure to them cause?

A

Chloroform and carbon tetrachloride
Exposure to high levels of vapors —> dizziness and confusion —>CNS depression and coma
Lower levels toxic for liver and kidneys

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2
Q

Occupational exposure of rubber workers to benzene and 1,3-butadiene lead to what?

A

Increased risk of leukemia
Benzene is oxidized leading to toxic metabolites that disrupt the differentiation of hematopoietic cells in the bone marrow —> dose dependent marrow aplasia and increased risk of acute myeloid leukemia (AML)

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3
Q

What are hte effects of polycyclic hydrocarbons?

A

Scrotal cancers in chimney sweeps

Among the most potent carcinogens and industrial exposure impacted in lung and bladder cancer

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4
Q

What are examples of organochlorines?

A

Important examples include pesticides and DDT

PCBs and dioxin

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5
Q

What can exposure to dioxins and PCBs cause?

A

Folliclulits and dermatosis known as chloracne characterized by acne, cyst formation, hyperpigmentation and hyperkeratosis, face and behind ears
Abnormalities in the liver and CNS

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6
Q

What are mineral dusts?

A

Coal dust, silica, asbestos, beryllium —> pneumoconiosis
Asbestosis (workers and family members) —> mesothelioma; black lung
Ferruginous bodies (absent fibers coated in iron)

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7
Q

What effect can bisphenol A (BPA) cause?

A

Potential endocrine disruptor (infants who drink from BPA containing containers may be particularly susceptible to its endocrine effects)

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8
Q

There is a ten fold increased incident in which type of workers?

A

Asbestos workers and uranium miners who smoke

Mulitplicative interaction: tobacco and alcohol —> laryngeal and oral cancers

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9
Q

Cigarette smoking is associated with cancers of the what?

A

Esophagus, pancreas, bladder, kidney, cervix and bone marrow

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10
Q

What are the most common diseases caused by cigarette smoking?

A

Emphysema, chronic bronchitis, COPD

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11
Q

There is a multiplicative increase in the risk of which type of cancer from the interaction between cigarette smoking and alcohol consumption?

A

Laryngeal cancer

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12
Q

What is the legal definition of drunk driving in the US?

A

80mg/dL

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13
Q

What level of alcohol can lead to drowsiness?

A

200mg/dL

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14
Q

What level of alcohol can lead to stupor?

A

300mg/dL

Anything above can lead to coma and possible respiratory arrest

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15
Q

Which enzyme is commonly low amongst Asians?

A

ALDH*2

Homozygous leads to nausea, flushing tachycardia and hyperventilation with ingestion of EtOH

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16
Q

What is acute alcoholism?

A

Mostly CNS effects (depressant, respiratory arrest), but also hepatic steatosis (fatty liver), acute gastritis and ulceration
Reversible if EtOH consumption is discontinued

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17
Q

What is chronic alcoholism?

A

Shortened life span due to damage of the liver, GI tract, CNS and CVS and pancreas

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18
Q

What is the main site of chronic alcohol injury?

A

Liver —> steatosis, alcoholic hepatitis, cirrhosis (associated with portal HTN and increased risk for hepatocellular carcinomas)

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19
Q

What are the effects of chronic alcoholism in the GI tract?

A

Bleeding from gastritis, gastric ulcer, or esophageal varices (assoc with cirrhosis)

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20
Q

What is alcoholic cardiomyopathy?

A

Dilated congestive cardiomyopathy, HTN

Heavy alcohol use associated with liver injury —> decreased HDL —> likelihood of coronary heart dz

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21
Q

What are the effects seen with fetal alcohol syndrome?

A

Microcephaly, growth retardation, facial anomalies in new borne
Decreased mental functions as child grows
First trimester most harmful

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22
Q

What can moderate amounts of alcohol result in?

A

Increased HDL
Inhibited platelet aggregation
Decreased fibrinogen levels possibly protecting against CAD

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23
Q

What is Wernicke’s encephalopathy?

A

Thiamine deficiency
Acute appearance of psychotic sx and opthalamoplegia
Acute sx are reversible when treated with thiamine
Foci hemorrhage and necrosis in the mammillary bodies and the walls of the 3rd and 4th ventricles

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24
Q

If Wernicke’s encephalopathy is unrecognized and untreated what can it lead to?

A

Korsakoff syndrome which is largely irreversible

Disturbances of short term memory and confabulation

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25
Q

What cerebellar dysfunction is seen with chronic alcoholics?

A

Truncal ataxia, unsteady gait, nystagmus

Histological changes including atrophy and loss of granule cells predominately in the anterior vermis

26
Q

Drug induced hypersensitivity reactions most commonly present as what?

A

Skin rashes

May mimic autoimmune diagnoses (SLE), hemolytic anemia or immune thrombocytopenia

27
Q

Which two anticoagulants cause the most frequent adverse reactions?

A

Warfarin and pradaxa
High levels cause bleeding
Low levels cause thrombosis due to insufficient dosages (e.g. stroke)

28
Q

What are the effects seen with menopausal hormone therapy (MHT)?

A

Estrogen-progestin combo increases breast cancer risk 5-6x
MHT may protect ASCVD
If 60 y/o increases risk of stroke and VTE (DVT and PE)

29
Q

What risks are seen with oral contraceptive use?

A

Doesnt increase breast cancer risk
Increased risk of cervical cancer esp HPV
Protects against endometrial and ovarian cancers
2-4x increased risk of venous thrombosis and PE
Does not increase CAD in women <30 y/o non smokers but 2x increase risk in smokers greater than 35 yo

30
Q

What effects can be seen with anabolic steroids?

A

Stunted growth, acne, gynecomastia, testicular atrophy
Facial hair and menstrual changes in females
Psychiatric issues
Increased risk for MI

31
Q

Describe effects of increased acetaminophen use (OD)

A

Centrilobular necrosis
Liver necrosis
Toxic dose 15-25g —> nausea, vomiting, diarrhea and shock

32
Q

What are the effects of acute salicylate poisoning?

A

Effects the brain —> nausea —> coma

33
Q

What does chronic salicylate use lead to?

A

Ha, dizziness, tinnitus, bleeding (plt dysfunction), coma

Erosive gastritis —> GI bleed —> gastric ulceration

34
Q

What is analgesic neprhopathy?

A

Phenacetin (active metabolite of aspirin) + aspirin over years —> renal papillary necrosis and analgesic nephropathy

35
Q

What are the effects of cocaine on neurotransmission?

A

Tachycardia, HTN, peripheral vasoconstriction

Coronary artery vasoconstriction + plt aggregation + thrombus formation —> myocardial ischemia (possible MI)

36
Q

What are other effects of cocaine?

A

Lethal arrhythmia (not dose related)
Decreased blood flow to placenta —> fetal hypoxia and spontaneous absorption
Effects on CNS include hyperpyrexia (fever) and seizures

37
Q

What are the effects of opiates?

A

Profound respiratory depression, arrhythmia, cardiac arrest and pulmonary edema
Sudden death may be unrelated to OD (tolerance)
Infections including endocarditis of right heart valves, subQ, liver, lungs

38
Q

The clinical significance of burn injury depends on what?

A

Depth of burn
% of body surface covered by burn
Internal injuries due to inhalation of toxic fumes and heat
Tx: fluid and electrolyte management and infection control

39
Q

What is the rule of nines?

A

Percentage of body effected by burn?

Look at figure

40
Q

What is a first degree burn?

A

Superficial

Epidermis only

41
Q

What is a 2nd degree burn?

A

Partial thickness

Extends to epidermis and dermis

42
Q

What is a 3rd degree burn?

A

Full thickness

Extend into the subcutaneous tissue

43
Q

What is a 4th degree burn?

A

Full thickness

Involves underlying muscle and subQ tissue

44
Q

What can thermal injuries lead to?

A

Shock, sepsis, respiratory insufficiency, hypertrophic scars

45
Q

Describe shock

A

Burns covering >20% of the body surface
Rapid shift of body fluids into interstitial compartment
Generalized edema including pulmonary edema, can be severe
Can result in a hypermetabolic state

46
Q

What is the hypermetabolic state that can occur during shock?

A

Excess heat loss and increased need for nutritional support

If more than 40% of body surface burned resting metabolic rate doubles

47
Q

What is the pugilistic stance?

A

State of body contraction after burns beyond recognition

48
Q

If all burns on the body are virtually colonized with either pseudomonas aeruginosa, MRSA or Candida species what can occur?

A

Sepsis

49
Q

What is hyperthermia?

A

Prolonged exposure to elevated ambient temperatures

Can lead to heat cramps, heat exhaustion, heat stroke

50
Q

What is malignant hyperthermia?

A

Heat stroke like rise in core body temperature and muscles contractures in response to common anesthetics
RYR1 gene

51
Q

What is hypothermia?

A

Body temp less than 90F —> loss of consciousness, bradycardia, then atrial fibrillation
Direct effects: frostbite, crystallization of intra and extracellular water
Indirect effects: vasoconstriction and increase vascular permeability —> edema and hypoxia —> hypoxia and infarction of extremities (gangrene)

52
Q

What determines the effect of ionization radiation on DNA?

A 
Rate of delivery 
Field size 
Cell proliferation 
O2 effects and hypoxia 
Vascular damage
53
Q

What are the three main radiation units?

A

Curie (Ci), gray (Gy) and Sievert (Sv)

54
Q

What are curie (Ci)?

A

Radiation emitted

55
Q

What is Gray (Gy) in terms of radiation units?

A

Energy absorbed

56
Q

What is Sievert (Sv)?

A

The equivalent dose (expressed in Sieverts) corresponds to the absorbed dose (expressed in Grays) multiplied by the relative biological effectiveness of the radiation

57
Q

What histologic features create a similarity between radiation injured and cancer cells?

A

Histologic constellation of cellular pleomorphism, giant cell formation, conformational changes in nuclei and abnormal mitotic figures
Creates problem for pathologists when evaluating irradiated tissues for the possible persistence of tumor cells

58
Q

Risk of which cancers increase from radiation exposure?

A

Leukemias, thyroid cancers and birth defects

Second cancers such as AML, myelodysplastic syndrome (MDS) and solid tumors

59
Q

What effects does radiation injury have on vasculature?

A

Radiation induced chronic vascular injury with sub-intimal fibrosis occluding the lumen

60
Q

Decompression sickness can result in what finding?

A

Surface hemorrhage

MOD Midterm (8 decks)

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