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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
What cerebellar dysfunction is seen with chronic alcoholics?
Truncal ataxia, unsteady gait, nystagmus | Histological changes including atrophy and loss of granule cells predominately in the anterior vermis
26
Drug induced hypersensitivity reactions most commonly present as what?
Skin rashes | May mimic autoimmune diagnoses (SLE), hemolytic anemia or immune thrombocytopenia
27
Which two anticoagulants cause the most frequent adverse reactions?
Warfarin and pradaxa High levels cause bleeding Low levels cause thrombosis due to insufficient dosages (e.g. stroke)
28
What are the effects seen with menopausal hormone therapy (MHT)?
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
What risks are seen with oral contraceptive use?
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
What effects can be seen with anabolic steroids?
Stunted growth, acne, gynecomastia, testicular atrophy Facial hair and menstrual changes in females Psychiatric issues Increased risk for MI
31
Describe effects of increased acetaminophen use (OD)
Centrilobular necrosis Liver necrosis Toxic dose 15-25g —> nausea, vomiting, diarrhea and shock
32
What are the effects of acute salicylate poisoning?
Effects the brain —> nausea —> coma
33
What does chronic salicylate use lead to?
Ha, dizziness, tinnitus, bleeding (plt dysfunction), coma | Erosive gastritis —> GI bleed —> gastric ulceration
34
What is analgesic neprhopathy?
Phenacetin (active metabolite of aspirin) + aspirin over years —> renal papillary necrosis and analgesic nephropathy
35
What are the effects of cocaine on neurotransmission?
Tachycardia, HTN, peripheral vasoconstriction | Coronary artery vasoconstriction + plt aggregation + thrombus formation —> myocardial ischemia (possible MI)
36
What are other effects of cocaine?
Lethal arrhythmia (not dose related) Decreased blood flow to placenta —> fetal hypoxia and spontaneous absorption Effects on CNS include hyperpyrexia (fever) and seizures
37
What are the effects of opiates?
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
The clinical significance of burn injury depends on what?
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
What is the rule of nines?
Percentage of body effected by burn? | Look at figure
40
What is a first degree burn?
Superficial | Epidermis only
41
What is a 2nd degree burn?
Partial thickness | Extends to epidermis and dermis
42
What is a 3rd degree burn?
Full thickness | Extend into the subcutaneous tissue
43
What is a 4th degree burn?
Full thickness | Involves underlying muscle and subQ tissue
44
What can thermal injuries lead to?
Shock, sepsis, respiratory insufficiency, hypertrophic scars
45
Describe shock
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
What is the hypermetabolic state that can occur during shock?
Excess heat loss and increased need for nutritional support | If more than 40% of body surface burned resting metabolic rate doubles
47
What is the pugilistic stance?
State of body contraction after burns beyond recognition
48
If all burns on the body are virtually colonized with either pseudomonas aeruginosa, MRSA or Candida species what can occur?
Sepsis
49
What is hyperthermia?
Prolonged exposure to elevated ambient temperatures | Can lead to heat cramps, heat exhaustion, heat stroke
50
What is malignant hyperthermia?
Heat stroke like rise in core body temperature and muscles contractures in response to common anesthetics RYR1 gene
51
What is hypothermia?
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
What determines the effect of ionization radiation on DNA?
``` Rate of delivery Field size Cell proliferation O2 effects and hypoxia Vascular damage ```
53
What are the three main radiation units?
Curie (Ci), gray (Gy) and Sievert (Sv)
54
What are curie (Ci)?
Radiation emitted
55
What is Gray (Gy) in terms of radiation units?
Energy absorbed
56
What is Sievert (Sv)?
The equivalent dose (expressed in Sieverts) corresponds to the absorbed dose (expressed in Grays) multiplied by the relative biological effectiveness of the radiation
57
What histologic features create a similarity between radiation injured and cancer cells?
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
Risk of which cancers increase from radiation exposure?
Leukemias, thyroid cancers and birth defects | Second cancers such as AML, myelodysplastic syndrome (MDS) and solid tumors
59
What effects does radiation injury have on vasculature?
Radiation induced chronic vascular injury with sub-intimal fibrosis occluding the lumen
60
Decompression sickness can result in what finding?
Surface hemorrhage

MOD Midterm (8 decks)

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