environmental Flashcards
are all chemical agents purposefully to cause problems
No, can be therapeutic and nontherapeutic
injuries or disorders that are caused by chemical or physical agents
Environmetal disease
where does protein energy malnutrition tend to occur
In poor countires
what is the area of medicine focusing on injuries of the workplace
Occupational med
what are the regulatory agencies to stop environment disorders
EPA
FDA
OSHA
consumer products safety commission
how can chemical agents come in to cause problems
Inhalation
ingestion
injection
absorption throught the skin
how often are people exposed to chem agents
2 mill/year is US
how often are child exposed to chemical agents
60% of exposures
what are the common chemical agents for children in the house
Cleaners Analgesics Cosmetics Plants Cold meds
what are the factors that affect chemical injuries
CLADME Concentraion Liberation- how a drug comes to be Absorption Distribution Metabolism- some drugs need to be metabolised to be effective/cause problems Excretion
how much chemical exposure is unintentional
90%
how are most people exosed to chemical agents
oral:73%
adverse drug events: 2%
what are the clinical signs of relatively minor Adverse drug reaction
Rashes
GI upset
what are the major adverse drug reactions
Anaphylaxis (penicillin)
blood clots
arrhythmias
Hematologic (anemia, thrombocytopenia, leukopenia)
what drugs tend to cause more adverse drug reactions
More potent drugs (commonly anti cancer)
how often do adverse drug reactions lead to ER visits
7-9%
how often do adverse drugs reactions lead to death once in the ER
10%
how much asprin can you take to cause death
2-4 grams in kids
10-30 grams in adults
how does asprin cause death
respiratory alkalosis
metabolic acidosis
what does chronic asprin taking do to the body
headaches dizziness ringing in ears drowsiness Mental status changes gastritis GI bleeding Nausea and vomiting progress to seizures and coma
how much must Acetaminophen must you take to OD
15-20 grams
what does Acetaminophen OD lead to
Liver damage
liver failure
death
what was the original use of exogenous estrogens
2002 HRT for menopausal symptoms
prevention of osteoporosis
what is the problem with long term use of Exogenous estrogens
elevated risk of breast cancer, stroke, blood clots
can you use exogenous estrogens at all now a days
Short term may have better risk benefit relationships
what also may have similar problems to exogenous estrogens
Oral contraceptives
where is lead found
urban air soil water food house dust batteries older paints gas
where are the sources of accupationlead
mining
foundries
what happens to lead when taken up by the body
- 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
how does Lead show in X-rays
leads to lead lines
how does lead affect the teeth
Gingival hyperpigmentation (lead line of soft tissue)
what does lead do to the CNS
mild learn difficulties
sensory and motor deficits
wrist drop and footdrop
what does lead do to the GI
Colicky pain - severe no localized
what does lead do to the kidney
Damages tubules, fibrosis, renal failure
what is the Pb threshold blod levels for concern
greater than 5micrograms per decileter
when do you begin chelation therapy for lead
greater than 45 micrograms per decileter
what percent of lead is absorbed in children and adults
Children:50%
adults:15-20%
what are the sedative hypnotic drugs
EtOH
barbiturates
Benzodiazeprines
what are the CNS stimulates
Coke
Amphetamines
what are opioids
Heroin morphine methadone codeine fentanyl
what are the hallucinogens
LSD
PCP
Mescaline
MDMA
what nonprescription drugs do people tend to abuse
Analgesics
Antihistamines
scopolamine
atropine
what is the negative effect of club drugs as dentist
Clenching of teeth
what is mechanical trauma
A physical agent such as an abrasion, contusions, laceration, incisions, punctions
what is the ideal body temp rnage
89-106F(31-41 C)
how much death does hyperthermia cause
greater than 5000 deaths per year in US
what causes hypothermia
prolonged exposure to low temps
what is a wond produced by scraping/rubbing leading to removal of a superfical layer of skin
Abrasion
what is a wound caused by a blunt object, doesn’t break the skin
damages blood vessles and extravasation of blood in tissues
Contusion
what is a tear in tissue, usually with irregular jagged edges
Lacerations
what affects the clinical significance of burns
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
what is the rule of 9 for determineing the total body surface invovled
head and neck: 9% trunk front: 18% trunk back: 18% arms: 9% hands: 1% each legs: 18% each perineum: 1%
what happens if you greater than 50% of body surface is invovled in a burn
grave prognosis
how much should be burned for shock
greater than 20% of body surface area
what happens when burns lead to shock
Hypovolemia (massive fluid shift)
Infection (pseudomonas, candida)
Electrolyte & nutrition (hypermetabolic due to need to repair and rebuild)
what can cause internal injury from burns
Fumes
CO
HCN
what tends to get damaged internally from burns
Upper respiratory tract
Lower respiratory tract
what cdelayed ondition may occur from internal injury due to burns
Acute respiratory distress syndrome (ARDS)
what is a prolonged exposure to increased ambient temp
Hyperthermia
what causes heat cramps
Related to exercise with loss of fluids and electrolytes
what causes heat exhaustin
Shock due to rapid hypovolemia
recovery from heat exhaustin
recover spontaneously
what happens in a state of heat exhaustin
colapse to allow blood to flow and redistribute
how high must temps be to cause heat stroke
greater than 40C
what are the symptoms of heat stroke
Peripheral vasodilation confuction coma ischemia muscle necrosis DIC
how deadly is heat stroke
High mortality rate
what can lead to hypothermia
High humidity
wet clothes
Vasodilation(EtOH)
temp for mild hypothermia
32-35 celcius (89-95)
Temp for moderate hypothermia
28-32 celcius (82-89)
temp for severe hypothermia
less than 28 celcius (82)
what happens in hypothermia
bradycardia
atrial fibrillation
loss of consciousness
when does frost bite occur
Temp of extremities fals below freezing
how does frost bite occur at the cellular level
leads to crystallization of water and cell damage
what are the indirect effect of chilling
vasoconstriction
edema
longterm atrophy and fibrosis
sources of radiation
Cosmic UV elemental (From earths crust as radon) med (diagnostic and therapeutic) industrial nuclear power weapons
forms of radiation
Electomagnetic waves (x ray and gamma) high energy neutrons and charged particles (alpha, beta, protons)
how can radiation causes cellular damage
Direct damage to DNA
inrectly
how does indirect cellular damage to DNA occur
production of free radicals to damge membranes, nucleic acids, and enzymes
what the eventual outcome of radiation injuries
reversible
cell death
fibrosis
the amount of energy absorbed by target tissue
Gray
relative biologic effect of energy
Sievert
what does a sievert roughly equal
About a gray
sieverts of a single chest x-ray
.01mSv
sieverts of a CT
2mSv to head
8 mSv to ab
sieverts of a single dental intraoral image
.002 mSv
sieverts of cone beam CT
.02-.08 mSv
how many sieverts should you be exposed to as an occupation
less than or equal to 50 mSv/yr
what happens to the skin after 2-3 days of radiation
erythema (redness)
what happens tot he skin after 2-3 weeks of radiation
edema
what happens to the skin after 4-6 weeks of radiation
blistering/desquamation
What happens to the skin after months to years to decades of radiation
Atrophy
fibrosis
Neoplasia
are hematopoietic/lymphoid tissues sensitive to radiation or nah
Sensitive
how do lymphocytes respond to raidation
decrease in hours
rebound in weeks to months
what happens to lymph nodes and spleen due to radiation
Lymph nodes and spleen shrink
what happens to PMN’s due to radiation
decrease over 1-2 weeks
rebound in 2-3 months
what is the problem with a decrease in PMN’s from radiation
susceptible to infections(more bacterial)
what happens to platelets and RBC’s due to radiation
Decrease
take a while to rebound
what is the problem with a decrease in lymphocytes from radiation
susceptible to fungal infections
what does radiation do to the gonads
both sexes are sensitive and can make you sterile
why are the lungs sensitive to radiation
Vascularity
what does radiation do to the lungs
pulmonary congestion and edema
ARDS
what does radiation do to the GI
very sensitive leading to ulcers, stricutres, increases risk for cancer
what does radation do to blood vessels
Endothelial cell injury then fibrosis and narrowing (ischemia)
how much radiation does it take to induce death
2Sv begins lethal range
7Sv death is certain
what dose of radiation is needed to cause hematopoietic acute radiation syndrome
2-10 Sv
what happens in hematopoietic acute radiation syndrome
Loss of WBC hair loss infection sepsis bleeding death 2-6 weeks
what dose of radiation is needed to cause GI acute radiation syndrome
10-20 Sv
what does GI acute radiation syndrome lead to
Vomiting Bloody diarrhea shock sepsis death in 5-14 days
what dose of radiation is needed to lead to Cerebral acute radiation syndrome
greater than 50 Sv
what does Cerebral acute radiation syndrome lead to
listlessness drowsiness seizures coma death in 1-4 hours
what determines what aspect of the body gets hit the hardest by large doses of radiation
the dose amount
are nutritional disease qualitative or quantitative
Both
what does an adequate diet have
Carbs
more carbs
probably some bread
All the other things are an after thought
what is primary malnutrition
Diet deficient in 1+ component
what is secondary malnutrition
Supply is okay
absorption, storage, utilization, excessive loss problem
causes of poor diet
SES ignorance of needs fads acute illnesses (increase in BMR) self imposed diet restrictions/habits (anorexia/bulimia) malabsorption syndromes (CF, Crohn) genetic disease
where is protein-energy malutrition common and how many are affected
in developing countires where 25% of children are affected
does protein-energy malnutrition lead to death
yes, major cause in kids less than 5 years old
how to asses nutritional status
body weight (age, sex, height norms) growth charts
what are the two major disorders caused by protein-energy malnutrition
Marasmus
Kwashiorkor
what are the two functional protein compartments
Somatic
Visceral
what is the somatic protein compartment
Skeletal muscles
what is the visceral compartment for protein
Liver
what does marasmus affect
The somatic protein compartment
what does Kwashiorkor affect
The visceral compartment
what does marasmus lead to
skinfold thickness
what does Kwashiorkor lead to
serum proteins (Albumin and trasferrin)
when can you tell that a child has marasmus clinically
when weight falls below 60% of normal
what causes marasmum
Deficiency of caloric intake
what happens in the body to respond to marsmus
Carabolize proteins for energy
Somatic protein compartment are depleted (visceral in reserve)
how do you look externally in marsmus
Extremities appear emaciated
head’s out of proportion (too large)
what are the affects of marasmus
Growth retard anemia Vitamine deficiency Immune deficiency bradycardia low body temp
what happens to the bone marrow in marsum
Hypoplastic
what happens to the immune sstem in marasmum
Tcell defects with infections such as thrush common
what happens to serum albumin in marsmum
relatively normal
what disease do marsmum tend to get
Thrush
what causes Kwashiorkor
Protein deficiency, not calorie deficiency
what is more severe Kwashiorkor or marasmus
Kwashiorkor
where is PEM found
africa
SE asia
what does the low albumin from kwashiorkor lead to
Generalized edema
what is the weight of kwashiorkor
60-80% of normal, but is due to edema
what happens to the skin in Kwashiorkor
Alternating zones of hyper and hypo pigementation with desquamation
what happens tot he hair in Kwashiorkor
change texture and color
what happens to the liver in Kwashiorkor
enlarged and fattty
lack of transprot proteins
what happens to the immune system in kwashiorkor
defects lead to infrections
what does kwashiorkor do to growth
retards it
where do we find PEM in the US
chronic illness
hospitalized patient
what is the form of PEM in cancer patients
Cachexia
what causes cachexia
decreased appettie of cancer patients
what happens in Cachexia
increased catabolism
what mediates Cachexia
Cytokines (IL-1, IL-6, TNF)
where do vitamine deficiencies come from
low socioecon with overall malnutrtion
what are the fat soluble vitamines
A
D
E
K
what do fat soluble vitamines need to be absorbed
healthy intestinal mucosa
bile
pancreatic secretions
where are vitamins stored
body tissues (not water)
what decreases absorbtion of vitameines
Inflammatory bowel disease (Crohn)
Cystic fibrossis
Alcoholic liver disease
what does vitamine A do
Prevent night blindness
augments differentiation of specialized epithelial cells
Enhanves immunityot infections
what are the three active forms of vitamine A
REtinol
Retinal
Retinoic acid
where does Vitamin A comefrom
Beta-arotenes
where is Vitamin A stored
liver for 6-12 months
where is Beta-carotenes found
yellow and green veggies animal products (liver, fish, eggs, milk)
what is vitamin A released with
Carrier, retinol binding protein
where is vitamin A deficiency common
worldwide, especially in 3rd countries
what is th eearly sign of vit A deficiency
impaired night vision
persistnace Vitamin A deficiency leads to what
- 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
