Environmental and Nutritional Disorders: Part III

Question 1

What three major symptoms does cocaine cause?

Answer 1

tachycardia, HTN, and peripheral vasoconstriction

Question 2

how does cocaine use lead to myocardial ischemia?

Answer 2

coronary artery vasoconstriction + platelet aggregation+ thrombus formation leads to myocardial ischemia

Question 3

what does cigarette smoking and cocaine use potentiate

Answer 3

cocaine induced coronary vasospasm

Question 4

what can be said about the lethal arrhythmias that are associated with cocaine use?

Answer 4

they are not dose related; so this could be a first time use of cocaine and it could be a very small amount and still cause lethal arrhythmias

Question 5

What effect does cocaine have on the placenta?

Answer 5

it decreases blood flow to the placenta, which causes fetal hypoxia and spontaneous abortion

Question 6

what effect does cocaine have on the CNS?

Answer 6

hyperpyrexia (fever) and seizures

Question 7

what are the major effects of opiate use?

Answer 7

profound respiratory depression, arrhythmia, cardiac arrest, and pulmonary edema

Question 8

if a drug abuser injects opiates or heroin, what could happen?

Answer 8

they are injecting into a vein so there could be an infection leading to endocarditis of the right side of the heart (NOT THE LEFT)

Question 9

what are the symptoms of methamphetamine use?

Answer 9

violent behavior, confusion, psychotic symptoms (paranoia and hallucinations)

Question 10

what is MDMA?

Answer 10

ecstasy; often spiked with other drugs which can enhance its effects on the CNS

Question 11

what are the effects of chronic use of ecstasy?

Answer 11

sleep disorders, depression, anxiety, and aggressive behavior

Question 12

what are the effects of marijuana?

Answer 12

increased heart rate, changes to blood pressure (could cause angina in a patient with CAD), cognitive and psychomotor impairment with continued use; there are also large carcinogens in smoke

Question 13

what are the effects of huffing/glue sniffing?

Answer 13

there is MRI detectable brain damage that ranges from mild to severe dementia

Question 14

what are the effects of bath salts?

Answer 14

agitation, psychosis, MI, and suicide

Question 15

if you open a body bag of a person that overdosed on opiates, what would you expect to find?

Answer 15

a foam cone centered over the nose and mouth–> bubble frothy fluid coming out of the lungs and out through the nose and mouth due to pulmonary edema

Question 16

The clinical significance of burn injuries depends on 4 things, what are they?

Answer 16

depth of the burn, % of body surface covered by the burn, internal injuries, and fluid and electrolyte management and infection control

Question 17

What classifies a burn as 1st degree?

Answer 17

superficial; epidermis only

Question 18

what classifies a burn as 2nd degree?

Answer 18

partial thickness; epidermis and dermis

Question 19

what classifies a burn as 3rd degree?

Answer 19

full thickness; extend into the subcutaneous tissue

Question 20

what classifies a burn as 4th degree?

Answer 20

full thickness; involves the underlying muscle and the subcutaneous tissue

Question 21

what percentage is the adult torso?

Answer 21

a: 18% p: 18%

Question 22

what percentage is the adult arm?

Answer 22

a: 4.5% p: 4.5%

Question 23

what percentage is the adult leg?

Answer 23

a: 9 p: 9%

Question 24

what percentage is the adult head?

Answer 24

a:4.5% p: 4.5%

Question 25

what percent is the male genitalia?

Answer 25

1%

Question 26

when we are talking about internal injuries what are we talking about?

Answer 26

inhalation of toxic fumes and heat injuries especially considering the trachea (important to consider this because this could cause issues when trying to incubate)

Question 27

when you have loss of skin, what issue arises?

Answer 27

maintenance of fluid and electrolyte balance--> must monitor

Question 28

What should you expect to see if a patient has more than 20% of their body surface covered in burns?

Answer 28

there will be a rapid shift of body fluids into the interstitial compartment leading to shock--> this ultimately can lead to PULMONARY EDEMA

Question 29

what happens if more than 40% of the body surface is burned?

Answer 29

the resting metabolic rate doubles

Question 30

what are some of the colonizations that occur on burns?

Answer 30

pseudomonas aeruginosa (most common), MRSA, and candida species

Question 31

what happens within 24-48 hours of being burned?

Answer 31

respiratory insufficiency--> direct heat effects on the upper airway (mouth, nose, trachea) and inhalation of noxious gases (Cl, sulfur dioxide, and ammonia)

Question 32

what is the stance that is found when bodies are burned beyond recognition?

Answer 32

pugilistic stance

Question 33

what is the effect of heat exhaustion?

Answer 33

sudden prostration and collapse; lack of cardiac compensation for hypovolemia caused by dehydration; if you rehydrate you should recover

Question 34

what are the signs of heat stroke?

Answer 34

sweating ceases and core body temperature rises to more than 40 degrees C, leading to multiorgan dysfunction

Question 35

what all occurs during heat stroke?

Answer 35

generalized vasodilation with peripheral pooling of blood and decreased effective circulating blood volume; hyperkalemia, tachycardia, arrhythmias

Question 36

what does sustained contractions of skeletal muscle lead to?

Answer 36

muscle necrosis (rhabdomyolysis)

Question 37

what regulates calcium release from the sarcoplasm (and the calcium leak stimulates the muscle contraction)?

Answer 37

the RYR1 gene

Question 38

what is malignant hyperthermia?

Answer 38

"heat stroke-like" rise in core body temp and muscle contractures in response to common anesthetics

Question 39

how do you treat malignant hyperthermia?

Answer 39

muscle relaxers

Question 40

what is hypothermia defined as?

Answer 40

when body temperatures fall below 90 degrees

Question 41

what can hypothermia lead to within the body?

Answer 41

loss of consciousness, bradycardia, then atrial fibrillation

Question 42

what could worsen hypothermia?

Answer 42

high humidity, wet clothing, and it is exacerbated by EtOH

Question 43

what are the direct effects of hypothermia?

Answer 43

frostbite (which is crystallization if the intra and extracellular water)

Question 44

what are the indirect effects of hypothermia?

Answer 44

vasoconstriction and an increase in vascular permeability, which leads to edema and hypoxia, which leads to hypoxia and infarction of the extremities which causes GANGRENE

Question 45

What is paradoxical undressing?

Answer 45

often times before a person dies from hypothermia, they experience a burst of extreme heat and it causes them to undress themselves

Question 46

when discussing electrical injuries, there are two types of injuries. What are these?

Answer 46

1) burns 2) ventricular fibrillation or cardiac-respiratory failure

Question 47

What does the extent of electrical injury depend on?

Answer 47

the strength (amps), duration, and path of current through body

Question 48

What are low-voltage electrical injuries?

Answer 48

typically household injuries; burn sites at entry and exit if sustained

Question 49

in low-voltage electrical injuries, the alternating currents induce what?

Answer 49

tetanic muscle spasms; irreversible grasp; spasm of the chest wall (asphyxia)

Question 50

what are high-voltage electrical injuries?

Answer 50

lightening is a classic example; causes paralysis of the medullary centers and more extensive burns

Question 51

what is the pattern that occurs on the skin if a patient has been struck by lightening?

Answer 51

lichtenberg figures (these are transient)

Question 52

What is the morphology after someone undergoes ionizing radiation?

Answer 52

nuclear swelling, giant cells, pleomorphic nuclei, >1 nucleus, cytoplasmic swelling

Question 53

what problem might a pathologist have when evaluating irradiated tissues for the possible persistence of tumor cells?

Answer 53

the histological constellation of cellular pleomorphism, giant-cell formation, conformational changes in nuclei, and abnormal mitotic figures creates a more than passing similarity between radiation-injured cells and cancer cells

Question 54

What are secondary cancers?

Answer 54

individuals who received radiation therapy for cancers such as Hodgkin's lymphoma may develop different cancers-secondary cancers- such as AML, myelodysplastic syndrome (MDS), and solid tumors

Question 55

if someone has radiotherapy to the mediastinum, what might happen?

Answer 55

they could get extensive fibrosis in the area- so not just the lungs, but the pericardial sac can become very thick and fibrotic and this can have some interference with its functionality