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MOD Midterm > Environmental and Nutritional Disorders: Part II > Flashcards

Environmental and Nutritional Disorders: Part II Flashcards

1
Q

smokeless tobacco leads to what cancer?

A

oral cancer

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2
Q

tobacco decreases the overall survival through what effects?

A

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

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3
Q

Is nicotine a direct cause of tobacco related diseases?

A

no, but it is strongly addictive

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4
Q

What effect does nicotine have on the body?

A

ganglionic stimulation and depression; tumor promotion

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5
Q

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

A

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

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6
Q

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

A

inflammation and increased mucus production (bronchitis)

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7
Q

cigarette smoke causes the recruitment of what to the lung?

A

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

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8
Q

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

A

polycyclic hydrocarbons and nitrosamines

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9
Q

what is a multiplicative effect?

A

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

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10
Q

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

A

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

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11
Q

what is the multiplicative effect of smokers and alcoholics?

A

higher incidence of laryngeal and oral cancers

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12
Q

cigarette smoking is associated with what cancers?

A

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

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13
Q

what are the most common diseases caused by cigarette smoking?

A

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

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14
Q

cigarette smoking is also strongly linked to what cardiac issue?

A

atherosclerosis and its major complication MI

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15
Q

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

A

higher incidence of MI

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16
Q

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

A

30-60k

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17
Q

what does maternal smoking increase the risk of?

A

spontaneous abortion, preterm births, and intrauterine growth retardation

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18
Q

What are some new smoking associated diseases?

A

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

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19
Q

What does electronic cigarettes put one at risk for?

A

acute lung injuries

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20
Q

What is alcohol abuse disorder?

A

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

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21
Q

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

A

drowsiness

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22
Q

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

A

stupor

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23
Q

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

A

coma and possibly respiratory arrest

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24
Q

What is EtOH tolerance?

A

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

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25
Q

what does alcohol dehydrogenase due to etoh?

A

it oxidizes it to acetaldehyde

26
Q

what happens to the acetaldehyde produced by alcohol dehydrogenase?

A

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

27
Q

what are ~50% of asians lacking?

A

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

28
Q

what are the effects of etoh on the CYP2E1 system?

A

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

29
Q

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

A

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

30
Q

what effect does alcoholism have on the brain?

A

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

31
Q

what are the effects of acute alcoholism on the body?

A

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

32
Q

what are the effects of chronic alcoholism on the body?

A

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

33
Q

what is cirrhosis of the liver associated with?

A

portal hypertension and increased risk for hepatocellular carcinoma

34
Q

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

A

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

35
Q

what does alcoholic cardiomyopathy lead to?

A

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

36
Q

what are the symptoms of fetal alcohol syndrome?

A

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

37
Q

what are the benefits associated with EtOH?

A

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

38
Q

what causes wernicke encephalopathy?

A

thiamine deficiency

39
Q

what is the clinical presentation of wernicke encephalopathy?

A

acute appearance of psychotic symptoms and ophthalmoplegia

40
Q

Is wernicke encephalopathy reversible?

A

yes- if treated with thiamine

41
Q

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

A

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

42
Q

what occurs if wernicke encephalopathy is untreated?

A

it leads to Korsakoff syndrome, which is irreversible

43
Q

what are the clinical presentations of korsakoff syndrome?

A

disturbances of short term memory and confabulation

44
Q

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

A

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

45
Q

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

A

problems with bone marrow or blood cells

46
Q

what is a common adverse reaction of the antibiotic minocycline?

A

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

47
Q

drug-induced hypersensitivity reactions most commonly present as what?

A

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

48
Q

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

A

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

49
Q

what is menopausal hormone therapy?

A

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

50
Q

what are the risks and benefits of MHT?

A

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

51
Q

what are the adverse effects of oral contraceptives?

A

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

52
Q

what are the risks for smokers taking oral contraceptives?

A

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

53
Q

what are hepatic adenomas?

A

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

54
Q

what are the adverse effects of anabolic steroids?

A

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

55
Q

what are the adverse effects of acetaminophen?

A

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

56
Q

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

A

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

57
Q

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

A

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

58
Q

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

A

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

59
Q

what causes death following overdose of aspirin?

A

alkalosis due to stimulation of respiratory center in the medulla

60
Q

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

A

nausea, coma

61
Q

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

A

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

62
Q

what causes analgesic nephropathy?

A

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

MOD Midterm (22 decks)

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