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environmental Flashcards

1
Q

are all chemical agents purposefully to cause problems

A

No, can be therapeutic and nontherapeutic

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2
Q

injuries or disorders that are caused by chemical or physical agents

A

Environmetal disease

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3
Q

where does protein energy malnutrition tend to occur

A

In poor countires

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4
Q

what is the area of medicine focusing on injuries of the workplace

A

Occupational med

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5
Q

what are the regulatory agencies to stop environment disorders

A

EPA
FDA
OSHA
consumer products safety commission

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6
Q

how can chemical agents come in to cause problems

A

Inhalation
ingestion
injection
absorption throught the skin

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7
Q

how often are people exposed to chem agents

A

2 mill/year is US

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8
Q

how often are child exposed to chemical agents

A

60% of exposures

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9
Q

what are the common chemical agents for children in the house

A 
Cleaners
Analgesics
Cosmetics
Plants
Cold meds
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10
Q

what are the factors that affect chemical injuries

A 
CLADME
Concentraion
Liberation- how a drug comes to be
Absorption
Distribution
Metabolism- some drugs need to be metabolised to be effective/cause problems
Excretion
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11
Q

how much chemical exposure is unintentional

A

90%

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12
Q

how are most people exosed to chemical agents

A

oral:73%

adverse drug events: 2%

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13
Q

what are the clinical signs of relatively minor Adverse drug reaction

A

Rashes

GI upset

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14
Q

what are the major adverse drug reactions

A

Anaphylaxis (penicillin)
blood clots
arrhythmias
Hematologic (anemia, thrombocytopenia, leukopenia)

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15
Q

what drugs tend to cause more adverse drug reactions

A

More potent drugs (commonly anti cancer)

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16
Q

how often do adverse drug reactions lead to ER visits

A

7-9%

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17
Q

how often do adverse drugs reactions lead to death once in the ER

A

10%

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18
Q

how much asprin can you take to cause death

A

2-4 grams in kids

10-30 grams in adults

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19
Q

how does asprin cause death

A

respiratory alkalosis

metabolic acidosis

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20
Q

what does chronic asprin taking do to the body

A 
headaches
dizziness
ringing in ears
drowsiness
Mental status changes
gastritis
GI bleeding
Nausea and vomiting
progress to seizures and coma
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21
Q

how much must Acetaminophen must you take to OD

A

15-20 grams

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22
Q

what does Acetaminophen OD lead to

A

Liver damage
liver failure
death

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23
Q

what was the original use of exogenous estrogens

A

2002 HRT for menopausal symptoms

prevention of osteoporosis

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24
Q

what is the problem with long term use of Exogenous estrogens

A

elevated risk of breast cancer, stroke, blood clots

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25
Q

can you use exogenous estrogens at all now a days

A

Short term may have better risk benefit relationships

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26
Q

what also may have similar problems to exogenous estrogens

A

Oral contraceptives

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27
Q

where is lead found

A 
urban air
soil
water
food
house dust
batteries
older paints
gas
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28
Q

where are the sources of accupationlead

A

mining

foundries

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29
Q

what happens to lead when taken up by the body

A
  • 85% taken up by bones and developing teeth to compete with Ca
    - interferes with remodeling
  • blocks/binderes incorporation of Fe into hemoglobia
    • anemia (microcytic, hypochromic)
  • neuro disturbances
  • wrist drop and footdrop
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30
Q

how does Lead show in X-rays

A

leads to lead lines

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31
Q

how does lead affect the teeth

A

Gingival hyperpigmentation (lead line of soft tissue)

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32
Q

what does lead do to the CNS

A

mild learn difficulties
sensory and motor deficits
wrist drop and footdrop

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33
Q

what does lead do to the GI

A

Colicky pain - severe no localized

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34
Q

what does lead do to the kidney

A

Damages tubules, fibrosis, renal failure

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35
Q

what is the Pb threshold blod levels for concern

A

greater than 5micrograms per decileter

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36
Q

when do you begin chelation therapy for lead

A

greater than 45 micrograms per decileter

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37
Q

what percent of lead is absorbed in children and adults

A

Children:50%
adults:15-20%

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38
Q

what are the sedative hypnotic drugs

A

EtOH
barbiturates
Benzodiazeprines

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39
Q

what are the CNS stimulates

A

Coke

Amphetamines

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40
Q

what are opioids

A 
Heroin
morphine
methadone
codeine
fentanyl
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41
Q

what are the hallucinogens

A

LSD
PCP
Mescaline
MDMA

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42
Q

what nonprescription drugs do people tend to abuse

A

Analgesics
Antihistamines
scopolamine
atropine

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43
Q

what is the negative effect of club drugs as dentist

A

Clenching of teeth

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44
Q

what is mechanical trauma

A

A physical agent such as an abrasion, contusions, laceration, incisions, punctions

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45
Q

what is the ideal body temp rnage

A

89-106F(31-41 C)

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46
Q

how much death does hyperthermia cause

A

greater than 5000 deaths per year in US

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47
Q

what causes hypothermia

A

prolonged exposure to low temps

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48
Q

what is a wond produced by scraping/rubbing leading to removal of a superfical layer of skin

A

Abrasion

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49
Q

what is a wound caused by a blunt object, doesn’t break the skin
damages blood vessles and extravasation of blood in tissues

A

Contusion

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50
Q

what is a tear in tissue, usually with irregular jagged edges

A

Lacerations

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51
Q

what affects the clinical significance of burns

A

percentage of total body surface involved
depth of burn
possible internal injuries from inhalation of hot gases and fumes
age
how fast
how well treated

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52
Q

what is the rule of 9 for determineing the total body surface invovled

A 
head and neck: 9%
trunk front: 18%
trunk back: 18%
arms: 9%
hands: 1% each
legs: 18% each
perineum: 1%
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53
Q

what happens if you greater than 50% of body surface is invovled in a burn

A

grave prognosis

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54
Q

how much should be burned for shock

A

greater than 20% of body surface area

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55
Q

what happens when burns lead to shock

A

Hypovolemia (massive fluid shift)
Infection (pseudomonas, candida)
Electrolyte & nutrition (hypermetabolic due to need to repair and rebuild)

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56
Q

what can cause internal injury from burns

A

Fumes
CO
HCN

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57
Q

what tends to get damaged internally from burns

A

Upper respiratory tract

Lower respiratory tract

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58
Q

what cdelayed ondition may occur from internal injury due to burns

A

Acute respiratory distress syndrome (ARDS)

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59
Q

what is a prolonged exposure to increased ambient temp

A

Hyperthermia

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60
Q

what causes heat cramps

A

Related to exercise with loss of fluids and electrolytes

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61
Q

what causes heat exhaustin

A

Shock due to rapid hypovolemia

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62
Q

recovery from heat exhaustin

A

recover spontaneously

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63
Q

what happens in a state of heat exhaustin

A

colapse to allow blood to flow and redistribute

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64
Q

how high must temps be to cause heat stroke

A

greater than 40C

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65
Q

what are the symptoms of heat stroke

A 
Peripheral vasodilation
confuction
coma
ischemia
muscle necrosis
DIC
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66
Q

how deadly is heat stroke

A

High mortality rate

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67
Q

what can lead to hypothermia

A

High humidity
wet clothes
Vasodilation(EtOH)

68
Q

temp for mild hypothermia

A

32-35 celcius (89-95)

69
Q

Temp for moderate hypothermia

A

28-32 celcius (82-89)

70
Q

temp for severe hypothermia

A

less than 28 celcius (82)

71
Q

what happens in hypothermia

A

bradycardia
atrial fibrillation
loss of consciousness

72
Q

when does frost bite occur

A

Temp of extremities fals below freezing

73
Q

how does frost bite occur at the cellular level

A

leads to crystallization of water and cell damage

74
Q

what are the indirect effect of chilling

A

vasoconstriction
edema
longterm atrophy and fibrosis

75
Q

sources of radiation

A 
Cosmic
UV
elemental (From earths crust as radon)
med (diagnostic and therapeutic)
industrial
nuclear power
weapons
76
Q

forms of radiation

A 
Electomagnetic waves (x ray and gamma)
high energy neutrons and charged particles (alpha, beta, protons)
77
Q

how can radiation causes cellular damage

A

Direct damage to DNA

inrectly

78
Q

how does indirect cellular damage to DNA occur

A

production of free radicals to damge membranes, nucleic acids, and enzymes

79
Q

what the eventual outcome of radiation injuries

A

reversible
cell death
fibrosis

80
Q

the amount of energy absorbed by target tissue

A

Gray

81
Q

relative biologic effect of energy

A

Sievert

82
Q

what does a sievert roughly equal

A

About a gray

83
Q

sieverts of a single chest x-ray

A

.01mSv

84
Q

sieverts of a CT

A

2mSv to head

8 mSv to ab

85
Q

sieverts of a single dental intraoral image

A

.002 mSv

86
Q

sieverts of cone beam CT

A

.02-.08 mSv

87
Q

how many sieverts should you be exposed to as an occupation

A

less than or equal to 50 mSv/yr

88
Q

what happens to the skin after 2-3 days of radiation

A

erythema (redness)

89
Q

what happens tot he skin after 2-3 weeks of radiation

A

edema

90
Q

what happens to the skin after 4-6 weeks of radiation

A

blistering/desquamation

91
Q

What happens to the skin after months to years to decades of radiation

A

Atrophy
fibrosis
Neoplasia

92
Q

are hematopoietic/lymphoid tissues sensitive to radiation or nah

A

Sensitive

93
Q

how do lymphocytes respond to raidation

A

decrease in hours

rebound in weeks to months

94
Q

what happens to lymph nodes and spleen due to radiation

A

Lymph nodes and spleen shrink

95
Q

what happens to PMN’s due to radiation

A

decrease over 1-2 weeks

rebound in 2-3 months

96
Q

what is the problem with a decrease in PMN’s from radiation

A

susceptible to infections(more bacterial)

97
Q

what happens to platelets and RBC’s due to radiation

A

Decrease

take a while to rebound

98
Q

what is the problem with a decrease in lymphocytes from radiation

A

susceptible to fungal infections

99
Q

what does radiation do to the gonads

A

both sexes are sensitive and can make you sterile

100
Q

why are the lungs sensitive to radiation

A

Vascularity

101
Q

what does radiation do to the lungs

A

pulmonary congestion and edema

ARDS

102
Q

what does radiation do to the GI

A

very sensitive leading to ulcers, stricutres, increases risk for cancer

103
Q

what does radation do to blood vessels

A

Endothelial cell injury then fibrosis and narrowing (ischemia)

104
Q

how much radiation does it take to induce death

A

2Sv begins lethal range

7Sv death is certain

105
Q

what dose of radiation is needed to cause hematopoietic acute radiation syndrome

A

2-10 Sv

106
Q

what happens in hematopoietic acute radiation syndrome

A 
Loss of WBC
hair loss
infection
sepsis
bleeding
death 2-6 weeks
107
Q

what dose of radiation is needed to cause GI acute radiation syndrome

A

10-20 Sv

108
Q

what does GI acute radiation syndrome lead to

A 
Vomiting
Bloody diarrhea
shock 
sepsis
death in 5-14 days
109
Q

what dose of radiation is needed to lead to Cerebral acute radiation syndrome

A

greater than 50 Sv

110
Q

what does Cerebral acute radiation syndrome lead to

A 
listlessness
drowsiness
seizures
coma
death in 1-4 hours
111
Q

what determines what aspect of the body gets hit the hardest by large doses of radiation

A

the dose amount

112
Q

are nutritional disease qualitative or quantitative

A

Both

113
Q

what does an adequate diet have

A

Carbs
more carbs
probably some bread
All the other things are an after thought

114
Q

what is primary malnutrition

A

Diet deficient in 1+ component

115
Q

what is secondary malnutrition

A

Supply is okay

absorption, storage, utilization, excessive loss problem

116
Q

causes of poor diet

A 
SES
ignorance of needs
fads
acute illnesses (increase in BMR)
self imposed diet restrictions/habits (anorexia/bulimia)
malabsorption syndromes (CF, Crohn)
genetic disease
117
Q

where is protein-energy malutrition common and how many are affected

A

in developing countires where 25% of children are affected

118
Q

does protein-energy malnutrition lead to death

A

yes, major cause in kids less than 5 years old

119
Q

how to asses nutritional status

A 
body weight (age, sex, height norms)
growth charts
120
Q

what are the two major disorders caused by protein-energy malnutrition

A

Marasmus

Kwashiorkor

121
Q

what are the two functional protein compartments

A

Somatic

Visceral

122
Q

what is the somatic protein compartment

A

Skeletal muscles

123
Q

what is the visceral compartment for protein

A

Liver

124
Q

what does marasmus affect

A

The somatic protein compartment

125
Q

what does Kwashiorkor affect

A

The visceral compartment

126
Q

what does marasmus lead to

A

skinfold thickness

127
Q

what does Kwashiorkor lead to

A

serum proteins (Albumin and trasferrin)

128
Q

when can you tell that a child has marasmus clinically

A

when weight falls below 60% of normal

129
Q

what causes marasmum

A

Deficiency of caloric intake

130
Q

what happens in the body to respond to marsmus

A

Carabolize proteins for energy

Somatic protein compartment are depleted (visceral in reserve)

131
Q

how do you look externally in marsmus

A

Extremities appear emaciated

head’s out of proportion (too large)

132
Q

what are the affects of marasmus

A 
Growth retard
anemia
Vitamine deficiency
Immune deficiency
bradycardia
low body temp
133
Q

what happens to the bone marrow in marsum

A

Hypoplastic

134
Q

what happens to the immune sstem in marasmum

A

Tcell defects with infections such as thrush common

135
Q

what happens to serum albumin in marsmum

A

relatively normal

136
Q

what disease do marsmum tend to get

A

Thrush

137
Q

what causes Kwashiorkor

A

Protein deficiency, not calorie deficiency

138
Q

what is more severe Kwashiorkor or marasmus

A

Kwashiorkor

139
Q

where is PEM found

A

africa

SE asia

140
Q

what does the low albumin from kwashiorkor lead to

A

Generalized edema

141
Q

what is the weight of kwashiorkor

A

60-80% of normal, but is due to edema

142
Q

what happens to the skin in Kwashiorkor

A

Alternating zones of hyper and hypo pigementation with desquamation

143
Q

what happens tot he hair in Kwashiorkor

A

change texture and color

144
Q

what happens to the liver in Kwashiorkor

A

enlarged and fattty

lack of transprot proteins

145
Q

what happens to the immune system in kwashiorkor

A

defects lead to infrections

146
Q

what does kwashiorkor do to growth

A

retards it

147
Q

where do we find PEM in the US

A

chronic illness

hospitalized patient

148
Q

what is the form of PEM in cancer patients

A

Cachexia

149
Q

what causes cachexia

A

decreased appettie of cancer patients

150
Q

what happens in Cachexia

A

increased catabolism

151
Q

what mediates Cachexia

A

Cytokines (IL-1, IL-6, TNF)

152
Q

where do vitamine deficiencies come from

A

low socioecon with overall malnutrtion

153
Q

what are the fat soluble vitamines

A

A
D
E
K

154
Q

what do fat soluble vitamines need to be absorbed

A

healthy intestinal mucosa
bile
pancreatic secretions

155
Q

where are vitamins stored

A

body tissues (not water)

156
Q

what decreases absorbtion of vitameines

A

Inflammatory bowel disease (Crohn)
Cystic fibrossis
Alcoholic liver disease

157
Q

what does vitamine A do

A

Prevent night blindness
augments differentiation of specialized epithelial cells
Enhanves immunityot infections

158
Q

what are the three active forms of vitamine A

A

REtinol
Retinal
Retinoic acid

159
Q

where does Vitamin A comefrom

A

Beta-arotenes

160
Q

where is Vitamin A stored

A

liver for 6-12 months

161
Q

where is Beta-carotenes found

A 
yellow and green veggies
animal products (liver, fish, eggs, milk)
162
Q

what is vitamin A released with

A

Carrier, retinol binding protein

163
Q

where is vitamin A deficiency common

A

worldwide, especially in 3rd countries

164
Q

what is th eearly sign of vit A deficiency

A

impaired night vision

165
Q

persistnace Vitamin A deficiency leads to what

A
  • Dry eyes (xerosis and xerophthalmia) to corneal damage
  • respiratory and urinary tracts undergo squamous metaplasia causing infection
  • immune deficiency leads to measles, pneumonia, infectious diarrhea

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