Environmental and Nutritional Disorders: Part II

Question 1

smokeless tobacco leads to what cancer?

Answer 1

oral cancer

Question 2

tobacco decreases the overall survival through what effects?

Answer 2

dose-dependent ( this is why it is important to ask pack-years when taking a history)

Question 3

Is nicotine a direct cause of tobacco related diseases?

Answer 3

no, but it is strongly addictive

Question 4

What effect does nicotine have on the body?

Answer 4

ganglionic stimulation and depression; tumor promotion

Question 5

What substances in tobacco smoke cause toxicity to cilia and what does this mean?

Answer 5

formaldehyde and nitrogen oxides; it paralyzes those cilial hairs, so they can’t remove unwanted things from entering the lungs–> gives us the smoker cough

Question 6

agents in tobacco smoke have a direct irritant effect on the tracheobronchial mucosa, which leads to what?

Answer 6

inflammation and increased mucus production (bronchitis)

Question 7

cigarette smoke causes the recruitment of what to the lung?

Answer 7

recruitment of leukocytes to the lung, with increase of local elastase production and subsequent injury to lung tissue leading to emphysema

Question 8

what are the potent carcinogens directly involved in the development of lung cancer?

Answer 8

polycyclic hydrocarbons and nitrosamines

Question 9

what is a multiplicative effect?

Answer 9

when something has a higher incidence of occurring due to an underlying condition or exposure to another toxin

Question 10

what is the multiplicative effect of smokers and asbestos and uranium workers?

Answer 10

there is a ten-fold higher incidence of lung carcinomas in asbestos and uranium workers who smoke

Question 11

what is the multiplicative effect of smokers and alcoholics?

Answer 11

higher incidence of laryngeal and oral cancers

Question 12

cigarette smoking is associated with what cancers?

Answer 12

esophagus, pancreas, bladder, kidney, cervix, liver, colon and bone marrow

Question 13

what are the most common diseases caused by cigarette smoking?

Answer 13

involve the lung and include: emphysema, chronic bronchitis, and COPD

Question 14

cigarette smoking is also strongly linked to what cardiac issue?

Answer 14

atherosclerosis and its major complication MI

Question 15

what is the multiplicative effect of those who smoke who also have HTN and hypercholesterolemia?

Answer 15

higher incidence of MI

Question 16

How many cardiac deaths in the US each year are associated with passive smoke exposure?

Answer 16

30-60k

Question 17

what does maternal smoking increase the risk of?

Answer 17

spontaneous abortion, preterm births, and intrauterine growth retardation

Question 18

What are some new smoking associated diseases?

Answer 18

increased risk of type II DM, RA, age-related macular degeneration, ectopic pregnancy, and erectile dysfunction

Question 19

What does electronic cigarettes put one at risk for?

Answer 19

acute lung injuries

Question 20

What is alcohol abuse disorder?

Answer 20

chronic relapsing brain disease characterized by impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences

Question 21

what occurs in a non-alcoholic when they consume 200 mg of etoh?

Answer 21

drowsiness

Question 22

what occurs in a non-alcoholic when they consume 300 mg etoh?

Answer 22

stupor

Question 23

what occurs in a non-alcoholic when they consume greater than 300 mg of etoh?

Answer 23

coma and possibly respiratory arrest

Question 24

What is EtOH tolerance?

Answer 24

chronic alcoholics metabolize EtOH at a higher rate because they are inducing higher levels of alcohol dehydrogenase in the liver

Question 25

what does alcohol dehydrogenase due to etoh?

Answer 25

it oxidizes it to acetaldehyde

Question 26

what happens to the acetaldehyde produced by alcohol dehydrogenase?

Answer 26

it is converted into to acetate by ADH, which is then utilized in the mitochondrial respiratory chain

Question 27

what are ~50% of asians lacking?

Answer 27

aldehyde dehydrogenase (ADH)- they have ALDH2 which is the inactive variant

Question 28

what are the effects of etoh on the CYP2E1 system?

Answer 28

it competes with other CYP2E1 substrates and delays drug catabolism, potentiating the depressant effects of narcotic, sedative, and psychoactive drugs in the CNS

Question 29

what is the relationship between etoh and gram negative bacteria that is in the intestine?

Answer 29

gram negative bacteria will release endotoxin, which causes a release of TNF from macrophages and Kupffer cells, which ultimately leads to hepatic injury

Question 30

what effect does alcoholism have on the brain?

Answer 30

cerebellar degeneration: atrophy of the superior part (anterior) of the vermis

Question 31

what are the effects of acute alcoholism on the body?

Answer 31

CNS effects (depressant, respiratory arrest) but also hepatic steatosis (fatty liver) acute gastritis, and ulceration

Question 32

what are the effects of chronic alcoholism on the body?

Answer 32

shortened life span due to damage to the liver, GI tract, CNS, cardiovascular system, and pancreas

Question 33

what is cirrhosis of the liver associated with?

Answer 33

portal hypertension and increased risk for hepatocellular carcinoma

Question 34

what is the effect of the thiamine deficiency associated with alcoholism?

Answer 34

peripheral neuropathies and Wernicke-Korsakoff syndrome, cerebral atrophy, cerebellar degeneration, and optic neuropathy

Question 35

what does alcoholic cardiomyopathy lead to?

Answer 35

dilated congestive cardiomyopathy and hypertension; heavy EtOH use associated with liver injury leads to decreased HDLs, which increases the likelihood of coronary heart disease

Question 36

what are the symptoms of fetal alcohol syndrome?

Answer 36

microcephaly, growth retardation, and facial anomalies in newborns; decreased mental function as child grows

Question 37

what are the benefits associated with EtOH?

Answer 37

moderate amounts (250 ml of wine) increases HDLs, which inhibit platelet aggregation, decreases fibrinogen levels, which possibly protect against coronary heart diease

Question 38

what causes wernicke encephalopathy?

Answer 38

thiamine deficiency

Question 39

what is the clinical presentation of wernicke encephalopathy?

Answer 39

acute appearance of psychotic symptoms and ophthalmoplegia

Question 40

Is wernicke encephalopathy reversible?

Answer 40

yes- if treated with thiamine

Question 41

what morphological features are found within the brain in patients with wernicke encephalopathy?

Answer 41

foci of hemorrhage and necrosis in the mammillary bodies and in the walls of the third and fourth ventricles

Question 42

what occurs if wernicke encephalopathy is untreated?

Answer 42

it leads to Korsakoff syndrome, which is irreversible

Question 43

what are the clinical presentations of korsakoff syndrome?

Answer 43

disturbances of short term memory and confabulation

Question 44

what are the symptoms associated with cerebellar dysfunctioning in chronic alcoholics?

Answer 44

truncal ataxia, unsteady gait, and nystagmus; histologic changes: atrophy and loss of granule cells in the anterior vermis

Question 45

almost half of all drug related deaths are due to what?

Answer 45

problems with bone marrow or blood cells

Question 46

what is a common adverse reaction of the antibiotic minocycline?

Answer 46

discoloration of the skin; the drug metabolite/iron/melanin pigment are deposited which creates the dark cutaneous involvement

Question 47

drug-induced hypersensitivity reactions most commonly present as what?

Answer 47

skin rashes, which may mimic autoimmune disorders, hemolytic anemia or immune thrombocytopenia

Question 48

what 2 drugs are the 2 most frequently reported to have adverse reactions?

Answer 48

warfarin( vitamin K antagonist) and pradaxa (inhibits thrombin) both are anticoagulants

Question 49

what is menopausal hormone therapy?

Answer 49

replaces estrogens with progesterone (ok in early menopause but not good for long term)

Question 50

what are the risks and benefits of MHT?

Answer 50

5-6x increased risk for breast cancer; may protect against ASCVD if less than 60 years old; increased risk of stroke and DVT/PE

Question 51

what are the adverse effects of oral contraceptives?

Answer 51

increased risk of cervical cancer especially if + for HPV; protects against endometrial and ovarian cancers; increased risk for venous thrombosis and PE

Question 52

what are the risks for smokers taking oral contraceptives?

Answer 52

they are 2x more likely to develop CAD if they are over 35 years old and smoke

Question 53

what are hepatic adenomas?

Answer 53

rare and benign; seen with older patients with prolonged oral contraceptive use

Question 54

what are the adverse effects of anabolic steroids?

Answer 54

stunted growth, acne, gynecomastia, testicular atrophy, facial hair, and menstrual changes in women, psychiatric issues, and increased risk of MI

Question 55

what are the adverse effects of acetaminophen?

Answer 55

unintentional overdoses; acute liver failures- centrilobular necrosis and liver transplant

Question 56

What is a normal dosing of acetaminophen? what is considered a toxic dose of acetaminophen? and what results when this level is reached?

Answer 56

.5 g; 15-25 g; nausea, vomiting, and shock

Question 57

how would you treat someone with acetaminophen overdose and when should you do it?

Answer 57

treat with N-acetylcysteine within 12 hours; this can stop liver damage from occurring

Question 58

what is considered an accident overdose of aspirin in children? and in adults?

Answer 58

children 2-4 grams; adults: 10-30 grams

Question 59

what causes death following overdose of aspirin?

Answer 59

alkalosis due to stimulation of respiratory center in the medulla

Question 60

what are the effects of acute salicylate poisoning on the brain?

Answer 60

nausea, coma

Question 61

what are the main effects of chronic salicylate poisoning (salicylism)?

Answer 61

TINNITUS; headache, dizziness, bleedings, coma; but focus on TINNITUS

Question 62

what causes analgesic nephropathy?

Answer 62

when a patient takes phenacetin (which is an active metabolite of aspirin) and aspirin over the years--> it leads to renal papillary necrosis and analgesic nephropathy