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My MOD 1 > Environmental and Nutritional Disorders > Flashcards

Environmental and Nutritional Disorders Flashcards

1
Q

Global Disease Burden (GDB)

A

estimates the burden imposed by environmental disease, including those caused by communicable and nutritional diseases

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2
Q

Disability adjusted life year (DALY)

A

sum of years of life LOST due to premature mortality and disability in a population

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3
Q

What happened to the GDB from 1990-2010? Cause?

A

increase in mortality due to HIV/AIDS

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4
Q

What is the leading global cause of health loss?

A

undernutrition

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5
Q

What is the leading cause of death in developed countries?

A

ischemic heart disease and cerebral vasculature disease

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6
Q

What are 5 of 10 leading causes of death in developing countries?

A

Infectious disease

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7
Q

50% of all deaths in kids younger than 5 years are attributed to what 3 diseases?

A

pneumonia, diarrheal disease, and malaria

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8
Q

What are the categories of emerging infectious diseases?

A

newly evolved strains or organisms- multi-drug resistant TB
pathogens endemic to other species that recently “jumped” to human population-HIV
pathogens that have been present in human population, but increase in incidence- dengue fever due to warming

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9
Q

What will be the preeminent global cause of environmental disease if no action is taken?

A

climate change

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10
Q

What will the health impacts of climate change depend on?

A

extent and rapidity, nature and severity of the consequences, and our ability to mitigate the damage

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11
Q

Affects of heatwaves and air pollution in disease

A

Cardiovascular, cerebrovascular, and respiratory diseases worsten

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12
Q

Contamination from floods and disruption of clean water supplies causes

A

Gastroenteritis, cholera, and other food-borne and waterborne infectious diseases

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13
Q

Examples and causes of vector-borne infectious diseases

A

malaria, Dengue fever; increased temperature, crop failures, and more extreme weather variations

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14
Q

Disrupted crop production causes what?

A

malnutrition

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15
Q

Toxicology

A

distribution, effects, and mechanisms of action of toxic agents

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16
Q

How many pounds of toxic chemicals and unrecognized carcinogens are released per year in the US?

A

4 billion pounds; 72 million lbs carcinogens

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17
Q

Xenobiotics

A

exogenous chemicals in the environment (air, water, food, soil) that may be absorbed into the body (inhaled, ingested, skin contact)

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18
Q

Lipophilic

A

can transport and penetrate through the basement membrane; most solvents and drugs

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19
Q

Detoxification

A

when solvents, drugs, and xenobiotics are metabolized to an inactive water-soluble product

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20
Q

What is the other outcome for solvents, drugs, and xenobiotics besides detox?

A

activated to form toxic metabolites

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21
Q

Phase 1 reaction of xenobiotics

A

hydrolysis, reduction, oxidation

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22
Q

Phase 2 reaction of xenobiotics

A

glucoronidation, sulfation, methylation, and conjugation

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23
Q

Cytochrome P-450

A

located in ER of the liver, also present in skin, lungs, GI mucosa
catalyzes reactions that either detoxify xenobiotics or convert them into active compounds that cause cell injury

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24
Q

What byproduct can P-450 produce?

A

ROS–>cell damage

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25
Q

Is the CYP activity between people the same?

A

No, great variation

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26
Q

What decreases the action of CYP?

A

fasting and starvation

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27
Q

Who is more susceptible to air pollution?

A

persons with preexisting pulmonary or cardiac disease

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28
Q

What are the major causes of morbidity and mortality when it comes to pollution?

A

airborne microorganisms

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29
Q

What are there limits on regarding air pollution?

A

sulfur dioxide, carbon monoxide, ozone, nitrogen dioxide, lead, and particulate matter

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30
Q

Where is smog the highest?

A

Beijing, LA, Houston, Cairo, New Delhi, Mexico City, and Sau Paulo

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31
Q

Ground level ozone toxicity

A

mediated free radicals; injure respiratory tract epithelial cells and type I alveolar cells, releasing inflammatory mediators–>mild symptoms

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32
Q

Who is more affected by ozone toxicity?

A

people with asthma or emphysema

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33
Q

Sulfur dioxide toxicity

A

combines with ozone and particulate matter–>witches brew

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34
Q

How is sulfur dioxide toxic made?

A

power plants burning fossil fuels, copper smelting, and byproduct of paper mills

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35
Q

What symptoms does sulfuric acid and sulfuric trioxide cause?

A

burning sensation in nose and throat, difficulty breathing, and asthma attacks

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36
Q

Particulate matter (soot)

A

pulmonary inflammation and secondary CV effects

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37
Q

What are the most harmful particulate matters?

A

fine or ultrafine particles less than 10 micrometers in diameter

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38
Q

What happens to particulate matter over 10 micrometers?

A

removed in the nose or trapped by the mucociliary epithelium of the airway

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39
Q

Carbon monoxide

A

nonirritating, colorless, tasteless, odorless gas produced when there is incomplete oxidation of the hydrocarbons

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40
Q

Chronic carbon monoxide poisoning

A

working in tunnels, underground garages, and in highway toll booths with high exposure to car fumes

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41
Q

Acute carbon monoxide toxicity

A

in a small, closed garage, the average running car can produce sufficient CO to induce coma or death within 5 minutes

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42
Q

How does CO kill?

A

inducing CNS depression, widespread ischemic changes
basal ganglia and lenticular nuclei
If death occurs rapidly, NO morphological changes

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43
Q

Longer survival with CO poisoning- what does brain look like?

A

May be slightly edematous, with punctate hemorrhages and hypoxia-induced neuronal changes

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44
Q

Symptoms if pt survives CO poisoning

A

impaired memory, vision, hearing, and speech

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45
Q

Pathophysiology of CO poisoning

A

Hb has a 200-fold greater affinity for CO than O; systemic hypoxia–>20-30% saturated with CO
unconsciousness and death- 60-70% saturation in less than 5 minutes

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46
Q

Appearance of someone with CO poisoning

A

cherry red color of the skin and mucous membranes

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47
Q

Wood smoke

A

polycyclic hydrocarbons are carcinogens

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48
Q

Bioaerosols

A

Legionnaires disease, viral pneumonia, pet dander, fungi, molds

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49
Q

Radon

A

radioactive gas derived from uranium; increased lung cancer risk

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50
Q

Formaldehyde

A

building materials, poorly ventilated trailers following disasters; carcinogen

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51
Q

Sick building syndrome

A

indoor pollutants, poor ventilation; flood-hit buildings

damp homes–>molds like aspergillus and penicilium–>allergic rhinitis and recurrent sinitus

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52
Q

Symptoms of sick building syndrome

A

headache, chest infection, chest congestion, congestion of nose and around eyes

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53
Q

Why are fine or ultrafine particles more dangerous?

A

readily inhaled into the alveoli, releasing a number of inflammatory mediators

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54
Q

Lead

A

readily absorbed metal that binds to sulfhydryl groups in proteins and interferes with Ca2+ metabolism

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55
Q

What effects do lead lead to?

A

hematologic, skeletal, neurologic, gastrointestinal, and renal toxicities

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56
Q

How can you get lead poisoning?

A

flaking lead paint and soil- kids

occupational exposure

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57
Q

Where is most of the absorbed lead incorporated in the body?

A

bone and developing teeth, competes with calcium; stays in bones 20-30 years

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58
Q

Effects of low levels of lead

A

subtle deficits in intellect, behavioral problems, hyperactivity, poor organization skills in kids–>brain damage

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59
Q

Brain damage with lead poisoning

A

sensory, motor, intellectual, and psychological impairments; decreased IQ, learning disabilities, retarded psychomotor development, blindness

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60
Q

Brain damage with severe lead poisoning

A

psychoses, seizures, and coma

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61
Q

How does Pb toxicity in a mother affect a fetus?

A

impair brain development in prenatal infant

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62
Q

Adult peripheral neuropathies due to lead

A 
CNS disturbances
Wrist drop (extensors), followed by paralysis of the peroneal muscles (foot drop)
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63
Q

Lead lines

A

radiodense deposits in metaphyses (interferes with remodeling of cartilage); also lead lines in the gums

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64
Q

Lead and its affects on blood

A

heme deficit–>hypochromic microcytic anemia, basophilic stippling, and ring sideroblasts (iron-laden mitochondria)

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65
Q

Lead colic

A

extremely severe, poorly localized abdominal pain

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66
Q

Renal affects of lead

A

proximal tubule damage, chronic damage–>interstitial fibrosis and possible renal failure

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67
Q

Microcytic hypochromic anemia

A

MCV < 80 fL
MCH < 27 pg
due to lead poisoning

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68
Q

Ringed sideroblast

A

associated with sideroblastic anemia, due to excess iron in mitochondria

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69
Q

What size should RBCs be?

A

The neutrophil of a small lymphocyte

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70
Q

Mercury

A

binds to sulfhydryl groups, damage CNS and kidney

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71
Q

Main source of mercury

A

contaminated fish (methyl mercury), mercury vapors from metallic mercury in dental amalgams

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72
Q

Minamata disease

A

cerebral palsy, deafness, blindness, MR, and major CNS defects in children exposed to mercury in utero

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73
Q

Arsenic

A

interfere with cell metabolism–> toxicities most prominent in the GI tract, nervous system, skin and heart (Borgia and Medici poisonings)

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74
Q

Where can arsenic be found?

A

soil and water (natural); wood preservatives, herbicides, herbal medicines

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75
Q

Large quantities of arsenic ingested cause toxicity where?

A

GI, cardiovascular, and CNS

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76
Q

2-8 weeks postexposure of arsenic

A

sensorimotor neuropathy, paresthesias, numbness, pain

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77
Q

Chronic skin changes due to arsenic

A

hyperpigmentation and hyperkeratosis

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78
Q

Arsenic leads to increased risk for cancers where?

A

lungs, bladder, and skin (palms and soles)

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79
Q

Cadmium

A

toxic to kidney and lungs via uncertain mechanisms that may involve increased ROS

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80
Q

Source of cadmium

A

nickel-cadmium batteries, soil, plants= food

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81
Q

What diseases does cadmium cause?

A

obstructive lung disease, renal tubular damage, skeletal abnormalities associated with calcium loss
increased risk of lung cancer

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82
Q

Itai-Itai

A

ouch-ouch; Japan; osteoporosis and osteomalacia with renal disease

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83
Q

Toxicants that can cause lung cancer

A

radon, asbestos, silica, nickel, arsenic, chromium, mustard gas, uranium

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84
Q

Toxicants that can cause fibrosis

A

silica, asbestos, cobalt

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85
Q

Benzene causes what?

A

leukemia

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86
Q

Vinyl chloride causes what?

A

liver angiosarcoma

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87
Q

Examples of organic solvents that are occupational health risks

A

chloroform and carbon tetrachloride–>CNS depression and coma

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88
Q

Exposure to benzene and 1,3-butadiene causes increased risk of what? Who is affected?

A

leukemia; rubber workers

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89
Q

What does benzene and 1,3-butadiene do to the body?

A

marrow aplasia and increased risk of acute myeloid leukemia

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90
Q

Polycyclic hydrocarbons

A

from combustion of fossil fuels; scrotal cancers in chimney sweeps
most potent carcinogens–>lung and bladder cancer

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91
Q

Organochlorines

A

synthetic lipophilic products that resist degradation

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92
Q

What is an important organochlorine?

A

DDT used in pesticides

PCBs and dioxin are nonpesticide organochlorines

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93
Q

Dioxins and PCBs

A

folliculitis and dermatosis- chloracne

abnormalities in liver and CNS

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94
Q

Chloracne

A

due to dioxins and PCBs

acne, cyst formation, hyperpigmentation and hyperkeratosis, face and behind ears

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95
Q

Mineral dusts

A

coal dust, silica, asbestos, beryllium–>pneumonconioses

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96
Q

Asbestos

A

mineral dust–>mesothelioma, black dust

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97
Q

Ferruginous bodies

A

due to mineral dusts–> asbestos fibers coated in iron

appear blue

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98
Q

Vinyl chloride

A

angiosarcomas in liver

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99
Q

Bisphenol A (BPA)

A

line almost all food bottles and cans

potential endocrine disruptor

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100
Q

Tobacco

A

leading exogenous cause of human cancers, 90% of lung cancers

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101
Q

Is tobacco use dose dependent?

A

Yes, pack years

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102
Q

What happens with cessation of smoking tobacco?

A

within 5 years decreases overall mortality and risk of death from CV disease; lung cancer decreases 21% within 5 years, but the excess risk persists for 30 years

103
Q

Nicotine

A

an alkaloid present in tobacco; not a direct cause of tobacco-related disease but is strongly addictive

104
Q

What does nicotine do to the body?

A

Increases HR and BP

105
Q

What does tobacco smoke affect and cause?

A

tracheobronchial mucosa–>inflammation and increased mucus production (bronchitis); emphysema

106
Q

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

A

polycyclic hydrocarbons and nitrosamines

107
Q

Ten-fold higher incidence of lung carcinomas in what workers who also smoke?

A

asbestos workers and uranium miners

108
Q

Multiplicative interaction

A

tobacco and alcohol–>laryngeal and oral cancers

109
Q

What facilitates the excretion of carcinogens?

A

CYPs; some intermediates, though, are electrophilic and form DNA adducts that can cause mutations in oncogenes and tumor suppressors

110
Q

What cancers are associated with cigarette smoke?

A

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

111
Q

What are the most common diseases caused by cigarette smoke involving the lung?

A

emphysema, chronic bronchitis, and COPD

112
Q

What CV disease is smoking strongly linked to?

A

atherosclerosis–>MI

113
Q

Multiplicative effect on MIs when combining smoking with what?

A

HTN and hypercholesterolemia

114
Q

Maternal smoking increases the risk of what?

A

spontaneous abortions, preterm births, and intrauterine growth retardation (IUGR)

115
Q

Passive smoke inhalation increases the risk of what?

A

1.3 x increased risk of lung cancer
risk of CAD and fatal MI
increased risk of asthma in children

116
Q

The risk of lung cancer is determined by what?

A

the number of cigarettes smoked

117
Q

Multiplicative increase in the risk of what kind of cancer from the interaction of alcohol and tobacco?

A

laryngeal cancer

118
Q

Ethanol ingested is directly proportional to what?

A

blood level

amount exhaled proportional to blood level, also

119
Q

What is the legal definition of drunk driving in the US?

A

80 mg/dL 0.8

120
Q

How many drinks gets an average individual to the legal limit?

A

3 standard drinks

121
Q

Level of alcohol that causes drowsiness?

A

200 mg/dL

122
Q

Level of alcohol that causes stupor?

A

300 mg/dL

123
Q

How is alcohol processed by the body?

A

oxidized to acetaldehyde in liver by alcohol dehydrogenase (ADH)–>acetate by ADH–>used by mito respiratory chain

124
Q

Why does alcohol cause increased susceptibility to other compounds?

A

inhibits metabolism of other compounds

includes drugs, anesthetics, carcinogens, and industrial solvents

125
Q

What does alcohol in high concentrations compete with? Causes?

A

CYP2E1 substrates

delays drug catabolism–>potentiates depressant effects of narcotic, sedative, and psychoactive drugs in the CNS

126
Q

What molecule is required to convert acetylaldehyde to acetic acid in the mitochondria? Consequences?

A

NAD+

increased NADH associated with increased lactic acid levels and steatosis (due to low NAD)

127
Q

Alcoholic cerebellar degeneration

A

atrophy of the superior part of the vermis

128
Q

Acute alcoholism

A

mostly CNS effects (depressant), but also hepatic steatosis, acute gastritis, and ulceration
reversible if EtOH consumption discontinued

129
Q

Chronic alcoholism

A

shortened lifespan due to damage to the liver, GI tract, CNS, CV system, and pancreas

130
Q

Alcohol and the liver

A

main site of chronic injury; steatosis, alcoholic hepatitis, and cirrhosis

131
Q

What is cirrhosis of the liver associated with in alcoholism?

A

portal hypertension and increased risk for hepatocellular carcinoma

132
Q

GI and chronic alcoholism

A

bleeding from gastritis, gastric ulcer, and esophageal varices

133
Q

Thiamine (vit B1) and chronic alcoholism

A

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

134
Q

Alcoholic cardiomyopathy

A

dilated congestive cardiomyopathy, HTN; decreased HDL–>increased risk of CAD

135
Q

Alcoholism and the pancreas

A

acute and chronic pancreatitis

136
Q

Fetal alcohol syndrome

A

microcephaly, growth retardation, and facial anomalies in newborn; decreased mental function as child grows; first trimester most harfmul

137
Q

Malnutrition and nutritional deficits and alcoholism

A

Vitamin B especially

138
Q

Minocycline can cause what to the skin?

A

discoloration; adverse drug reaction

139
Q

Drug-induced hypersensitivity reactions most commonly present as what?

A

skin rashes

140
Q

Anticoagulant

A

warfarin (vitamin K antagonist) and dabigatran (inhibits thrombin)
causes bleeding; thrombosis due to insufficient dosage (stroke)

141
Q

Menopausal hormone therapy (MHT)

A

estrogens with progesterone; not good long term

142
Q

Oral contraceptives

A

do NOT increase breast cancer risk; increase cervical cancer due to HPV; increased risk of venous thrombosis and PE; does NOT increase CAD in women under 30, but increases it 2x in smokers
hepatic adenoma- rare and benign, older pt with prolonged OC use

143
Q

Anabolic steroids

A

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

144
Q

Acetaminophen

A

50% unintentional OD; 50% of acute liver failures with 30% mortality; centrilobular necrosis

145
Q

Aspirin

A

acute salicylate poisoning affects the brain–>nausea–>coma

chronic (salicylism)–>HA, dizziness, tinnitus, bleeding, coma; analgesic nephropathy

146
Q

How is acetaminophen metabolized 95% of the time?

A

detox by phase II enzymes–>excretion in urine as glucuronate or sulfate conjugate–>no toxicity

147
Q

How is acetaminophen metabolized 5% of the time?

A

CYP2E1 activity–>NAPQ–>protein adducts lipid peroxidation–>hepatocyte necrosis–>liver failure

148
Q

Opiates cause what?

A

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

149
Q

10% of the time, what infection occurs with opiates?

A

endocarditis right heart valves

150
Q

Methamphetamine causes what?

A

violent behavior, confusion, psychotic symptoms

151
Q

Marijuana

A

increases HR, can increase or decrease BP which may cause right angina in pt with CAD; cognitive and psychomotor impairment with continued use; large numbers of carcinogens in smoke

152
Q

Huffing/glue sniffing

A

MRI-detectable brain damage that ranges from mild-severe dementia

153
Q

Cocaine

A

tachycardia, HTN, and peripheral vasoconstriction
coronary artery vasoconstriction and platelet aggregation–>thrombus–myocardial ischemia
lethal arrhythmias (NOT dose dependent)
decreased blood flow to placenta–>fetal hypoxia and spontaneous abortion
hyperpyrexia and seizures

154
Q

Clinical significance of burn injury depends on what?

A

depth of burn, % of body surface covered by burn

internal injuries: inhalation of toxic fumes and heat

155
Q

Treatment of burns

A

fluid and electrolyte management and infection control

156
Q

1st degree burn

A

superficial; epidermis only

157
Q

2nd degree burn

A

partial thickness; epidermis and dermis

158
Q

3rd degree burn

A

full thickness; extend into the subcutaneous tissue

159
Q

Shock in regards to thermal injuries

A

burns greater than 20% of body surface–>rapid shift of body fluids into interstitial compartment–>shock

160
Q

Clinical signs of shock due to thermal injuries

A

generalized edema, pulmonary edema, can be severe

hypermetabolic state

161
Q

Sepsis due to burns

A

all burns are colonized; Pseudomonas aeruginosa, MRSA, Candida

162
Q

Respiratory insufficiency due to burns

A

24-48 hrs, direct heat effects on upper airway and inhalation of noxious gases

163
Q

Pugilistic stance

A

looks like a boxer; burned beyond recognition

164
Q

Hyperthermia

A

heat stroke= lack of sweating

165
Q

Malignant hyperthermia

A

“heat stroke-like”; rise in core body temperature and muscle contractures in response to common anesthetics; RYR1 gene

166
Q

Hypothermia

A

body temp < 90 degrees–> loss of consciousness, bradycardia, then Afib

167
Q

2 types of electrical injury

A

burns and lightening classic high-voltage electrical injury

ventricular fibrillation or cardiac-respiratory failure

168
Q

Radiation units

A

Curie (CI), gray (Gy), Sievert (Sv)

169
Q

Curie

A

radiation emitted

170
Q

Gray

A

energy absorbed

171
Q

Sievert

A

the equivalent dose corresponds to the absorbed dose (grays) multiplied by the relative biological effectiveness of the radiation

172
Q

Determinants of effect of ionizing radiation on DNA

A 
rate of delivery
field size
cell proliferation
O2 effects and hypoxia
vascular damage
173
Q

Indirect effect of ionizing radiation

A

ionization–>free radical formation–>DNA damage

174
Q

Morphology of ionizing radiation

A

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

175
Q

What happens to irradiated vessels in ionizing radiation?

A

endothelial cell proliferation, collagenous hyalinization and thickening of the intima–>marked narrowing or even obliteration of the vascular lumens

176
Q

What causes scarring and contractions caused from ionizing radiation?

A

increased interstitial collagen in the irradiated field

177
Q

What cells histologically look like cancer cells and why?

A

radiation-injured cells; cellular pleomorphism, giant-cell formation, conformational changes in nuclei, and abnormal mitotic figures

178
Q

Cancer risks from radiation exposure

A

increased incidence of leukemias and solid tumors in Hiroshima and Nagasaki survivors
thyroid cancers in survivors of Chernobyl
increased frequency of leukemias and birth defects in Marshall islands
development of secondary cancers such as acute myeloid leukemia, myelodysplastic syndrome, and solid tumors in individuals who received radiation therapy for cancers such as Hodgkin’s lymphoma

179
Q

Subintimal fibrosis

A

radiation-induced chronic vascular injury; occludes the lumen

180
Q

Malnutrition

A

protein energy malnutrition, PEM; consequence of inadequate intake of proteins and calories or deficiencies in the digestion or absorption of proteins–>loss of fat and muscle tissue, weight loss, lethargy, and generalized weakness

181
Q

Obesity leads to

A

diabetes, atherosclerosis, and cancer

182
Q

Primary dietary insufficiency

A

missing from diet

183
Q

Secondary dietary insufficiency

A

malabsorption, impaired utilization or storage, excess loss or increased need

184
Q

What causes dietary insufficiency?

A

poverty, infections, acute and chronic illnesses, chronic alcoholism, ignorance, self-imposed dietary restrictions, GI diseases, and malabsorption syndrome

185
Q

Protein-energy malnutrition (PEM)

A

50% deaths in infancy and childhood in developing countries; older and debilitated patients in nursing homes and hospitals

186
Q

Weight loss of more than how much is associated with PEM in nursing home patients?

A

5%; increased mortality in nursing home pts

187
Q

Signs of secondary PEM

A

depletion of subcutaneous fat in the arms, chest wall, shoulders, or metacarpal regions, wasting of the quads and deltoid muscles, and ankle or sacral edema

188
Q

Marasmus

A

weight <60% normal for sex, height, and age; growth retardation and muscle loss
serum albumin normal; anemia; immune deficiency
Muscle proteins and sub! fat used as fuel–>emaciated extremities

189
Q

Kwashiorkor

A

decreased protein more severe–>decrease in total calories

190
Q

Hypoalbuminemia is seen with what malnutrition disease?

A

Kwashiorkor

generalized or dependent edema–>vitamin deficiency, immune deficiency and secondary infections

191
Q

Other symptoms of Kwashiorkor

A

depletion of visceral protein compartment; fatty liver; sparing of subQ fat and muscle
chronic diarrhea, protein loss enteropathies, nephrotic syndrome, extensive burns, fat diets or replacement of milk with rice-based beverages

192
Q

Cause of Kwashiorkor in Ghana and Southeast Asia

A

weaned too early and fed carb diet

193
Q

Cachexia

A

PEM complication in AIDS or advanced cancers
50% of cancer pts; GI, pancreatic, and lung cancers
extreme weight loss, fatigue, muscle atrophy, anemia, anorexia, and edema
mortality from atrophy of the diaphragm and other respiratory muscles

194
Q

Mechanism of cancer cachexia

A

NF kappa B is activated–>muscle specific ubiquitin ligases–>ubiquitinylation of myosin heavy chains–>proteasome–>loss of myofibrils, loss of muscle mass

195
Q

Anorexia nervosa

A

self-induced starvation–>market weight loss
highest death rate of any psychiatric DO
amenorrhea, decreased thyroid hormone, decreased bone density

196
Q

Bulimia

A

binge/purge; more common than anorexia and better prognosis
Electrolyte imbalance (hypokalemia)–>cardiac arrhythima
pulmonary aspiration of gastric contents
esophageal and gastric rupture

197
Q

What is a complication of both anorexia and bulimia?

A

cardiac arrhythmia and sudden death due to hypokalemia

198
Q

Vitamin A

A

retinol, retinal, and retinoic acid

199
Q

Purpose of Vitamin A

A

maintenance of normal vision, regulation of cell growth and differentiation and regulation of lipid metabolism

200
Q

Secondary Vitamin A deficiency can be seen with what other disorders?

A

Fat malabsorption (celiac disease, Crohn disease, colitis, CF, bariatric surgery, mineral oil laxative)

201
Q

When do Vitamin A deficiencies in kids occur?

A

stores depleted when they have infections; absorptio of vitamin A poor in newborns

202
Q

Effects of Vit A deficiencies

A

Night blindness
Epithelial/squamous metaplasia and keratinization
Xeropthalmia (dry eyes), Bitot spots, keratomalacia

203
Q

Squamous metaplasia of the respiratory epithelium

A

Vitamin A deficiency result; increase in pulmonary infections

204
Q

Immune deficiency in Vitamin A deficiency

A

increased mortality rates from common infections

205
Q

Actue Vit A toxicity

A

headache, dizziness, V, stupor and blurred vision; confused with pseudotumor cerebri

206
Q

Chronic Vit A toxicity

A

weight loss, anorexia, N&V, bone and joint pain

207
Q

Vitamin D

A

Cholecalfciferol, Vitamin D3

208
Q

Fat-soluble Vitamin D purpose

A

maintenance of adequate plasma levels of calcium and phosphorous to support metabolic functions, bone mineralization, and neuromuscular transmission

209
Q

What is Vit D required to prevent?

A

rickets, osteomalacia, and hypocalcemic tetany

210
Q

Rickets

A

frontal bossing, squared head, rachitic rosary, pigeon breast deformity, lumbar lordosis, bowing of the legs

211
Q

Osteomalacia

A

inadequate mineralization of bone, weak and prone to fracture

212
Q

Immune response of Vit D

A

helps clear Mycobacterium tuberculosis infections

213
Q

Vitamin D metabolism

A

endogenous synthesis from 7-dehydrocholesterol, in a photochemical reaction that requires solar or artificial UV light

214
Q

Insufficient sunlight and Vit D deficiency

A

decreased serum Ca and P–>Increased PTH–> mobilization of Ca and P from bones–>decreased serum Ca and P product–>poor bone mineralization

215
Q

What is lost in rickets?

A

cartilage palisades

216
Q

Vitamin C

A

ascorbic acid

217
Q

Deficiency of water-soluble Vit C

A

scurvy, bone diseases in growing children, hemorrhages, and healing defects in children and adults

218
Q

Where do we get Vit C?

A

Not synthesized endogenously; strictly from diet

Milk, liver, fish, abundant in fruits and vegetables

219
Q

Secondary Vit C deficiency

A

older individuals that live alone and chronic alcoholics, have erratic and inadequate eating patterns

220
Q

Vitamin C deficiency

A

poor vessel support results in bleeding tendency, inadequate synthesis of osteoid, impaired wound healing

221
Q

Acrodermatitis enteropathica

A

rash around eyes, mouth, nose, and anus due to zinc deficiency

222
Q

Iron deficiency causes what

A

hypochromic microcytic anemia

223
Q

Iodine deficiency causes what

A

goiter and hypothyroidism

224
Q

Copper deficiency causes what?

A

muscle weakness, neuro defects, abnormal collagen cross-linking

225
Q

Fluoride deficiency causes what

A

dental caries

226
Q

Selenium deficiencies cause what

A

myopathy, cardiomyopathy (Keshan disease)

227
Q

Obesity is associated with what?

A

excess adiposity (obesity) and excess body weight associated with increased incidence of type 2 DM, dyslipidemias, CV disease, HTN, and cancer

228
Q

Obesity

A

an accumulation of adipose tissue that is of sufficient magnitude to impair health

229
Q

Normal BMI of obese pt

A

Greater than 30 kg/m2

230
Q

Normal BMI

A

18.5-25

231
Q

Overweight BMI

A

between 25 and 30

232
Q

Central, or visceral, obesity

A

fat accumulates in trunk and abdominal cavity (mesentery and around viscera); associated with increased risk for several diseases–>excess accumulation of fat diffusely in subcutaneous tissue

233
Q

Regulation of energy balance

A

involves Hypothalamus, leptin, insulin, ghrelin, intestines, and food intake, energy expenditure, and energy balance

234
Q

Leptin

A

increases POMC/CART–>catabolic–>MC3/4R, alpha MSH–>causes endocrine and autonomic to secrete TRH and CRH–>energy consumption
also inhibits NPY/AgRP

235
Q

Pyy (intestines)

A

inhibits NPY/AgRP

236
Q

Ghrelin (stomach)

A

activates NPY/AgRP–>anabolic–> NPY and Y1/5 receptors–>behavioral releases MCH, orexins–>food intake

237
Q

Metabolic syndrome

A

visceral or intra-abdominal adiposity, insulin resistance, hyperinsulinemia, glucose intolerance, HTN, hypertriglyceridemia, and decreased HDL
obesity is the main driver

238
Q

Hypertriglyceridemia and low HLD is seen in what pts? Risks?

A

Obese people; CAD

239
Q

What affect on the liver does obesity have?

A

nonalcoholic fatty liver disease

240
Q

What is 6x greater in obese pts than lean ones?

A

Cholelithiasis (gallstones)

241
Q

Pickwickian syndrome

A

hypoventilation syndrome associated with obesity

Hypersomnolence–>sleep apnea, polycythemia, and eventual right sided heart failure (cor pulmonale)

242
Q

Marked adiposity predisposes to the development of what?

A

osteoarthritis

243
Q

What kind of cancers are at increased risk in obese patients?

A

esophagus, pancreas, colon, rectum, breast, endometrium, kidney, thyroid, and gallbladder

244
Q

What does insulin resistance lead to?

A

hyperinsulinemia–>increased free insulin like growth factor-1; mitogen

245
Q

What does obesity increase the synthesis of?

A

estrogen

246
Q

What can the proinflammatory state that is associated with obesity be?

A

carcinogenic

247
Q

Aflatoxin

A

hepatocellular carcinoma

248
Q

Nitrosamines and nitrosamides

A

gastric carcinomas

249
Q

High animal fat and low fiber

A

colon cancer

250
Q

Total dietary fat positively correlates with what?

A

breast cancer

251
Q

Vit C and E, beta-carotenes, and selenium seem to have what affects due to antioxidant properties?

A

Anticarcinogenic

252
Q

What kind of cancer does arsenic poisoning lead to?

A

Angiosarcoma of the liver

253
Q

What microbe is associated with burns and necrosis caused by burns?

A

Pseudomonas aeruginosa

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