Environmental and Nutritional Pathology

Question 1

What is the definition of environmental pathology?

Answer 1

Study of diseases and health conditions that arise from exposure to harmful external substances and deficiencies of essential substances within various environments

Question 2

What are xenobiotics?

Answer 2

Exogenous chemicals that can enter the body via inhalation, ingestion, or skin contact

Question 3

What is the MOA of xenobiotics?

Answer 3

Can act at the site of entry or be transported to other sites
May solvents/drugs are metabolized to detoxify or can form toxic metabolites

Question 4

What is the cytochrome P-450 system?

Answer 4

Key cellular enzyme system for detoxifying xenobiotics and activating toxic compounds
Predominantly found in the ER of the liver

Question 5

What are the functions of the CYP450 system?

Answer 5

Converts non-toxic substances into reactive oxygen species that can cause cellular damage

Question 6

What factors affect P-450 activity?

Answer 6

Genetic polymorphisms, drug interactions, lifestyle factors

Question 7

What populations are vulnerable to outdoor air pollution?

Answer 7

Disproportionate exposure among marginalized communities with lower socioeconomic status

Question 8

Describe the characteristics of outdoor air pollution.

Answer 8

• Ambient air contains a mixture of gaseous and particulate pollutants
• Greater contamination in urban areas and near heavy industry

Question 9

What are the five key pollutants monitored by the EPA?

Answer 9

Sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), particulate matter (PM)

Question 10

What are the major indoor air pollutants?

Answer 10

Tobacco and wood smoke, carbon monoxide, nitrogen dioxide, bioaerosols (biological agents - bacteria, molds, viruses), asbestos, sick building syndrome, radon

Question 11

Smoke from organic material burning contains what?

Answer 11

Various oxides of nitrogen and carbon particulates; may include carcinogenic polycyclic hydrocarbons

Acts as an irritant, increasing susceptibility to lung infections

Question 12

What is radon?

Answer 12

A radioactive gas derived from uranium found in soil and homes, known to cause lung cancer in uranium miners

Question 13

Bioaerosols can lead to illnesses like what?

Answer 13

Legionnaires’ Disease, viral pneumonia, common cold

Question 14

What are allergens?

Answer 14

Derived from pet dander, dust mites, fungi, and molds
Associated with respiratory issues: rhinitis, eye irritation, asthma

Question 15

What heavy metals are most commonly linked to harmful effects in humans?

Answer 15

Lead, mercury, arsenic, and cadmium

Question 16

What are sources of exposure for lead toxicity?

Answer 16

• Contaminated air, food, and water
• Historically significant sources include: house paints (flaking lead paint), leaded gasoline, mines, foundries, batteries, and spray paints (occupational hazards)

Question 17

What is a common source of lead exposure in children?

Answer 17

Paint chips

Question 18

What are some features you might see in a patient with lead poisoning?

Answer 18

• Burton line (dark line) in the gingiva
• Anemia associated with a distinctive punctate basophilic stippling of red blood cells
• Increased bone density detected as radiodense “lead lines”

Question 19

What are sources of mercury exposure?

Answer 19

• Contaminated fish
• Organic compounds (methyl mercury) produced by bacteria
• Bioaccumulation in the food chain

Question 20

What are symptoms of methyl mercury exposure in the GI tract?

Answer 20

Vomiting, abdominal pain, bloody diarrhea

Question 21

What can methyl mercury exposure cause in the kidney?

Answer 21

Renal damage and acute toxicity (renal tubular injury)

Question 22

What effects can methyl mercury have on the developing brain?

Answer 22

Risks include cerebral palsy, deafness, blindness, CNS defects

Question 23

What can chronic arsenic intoxication cause?

Answer 23

GI-CV issues, encephalopathy and peripheral neuropathy, cancers (skin, respiratory, GI tract)

Question 24

What is the leading preventable cause of death?

Answer 24

Smoking, with 440,000 deaths annually

Question 25

What diseases can smoking cause?

Answer 25

Ischemic diseases like coronary heart disease, lung cancer, and chronic obstructive pulmonary disease (emphysema, chronic bronchitis)

Question 26

What is Thromboangiitis Obliterans (Buerger Disease)?

Answer 26

Occlusive inflammatory disease, peripheral vascular disease with medium and small arteries in the distal arms and legs
Can be caused by smoking

Question 27

What other cancers besides lung cancer can be caused by smoking?

Answer 27

Lip, tongue, and buccal mucosa, larynx, esophagus, carcinoma of the kidney, pancreas, uterine cervix cancer, leukemia (acute myelogenous)

Question 28

What are adverse effects of acute alcoholism?

Answer 28

Decreased CNS activity: disordered cortical, motor, intellectual behavior; respiratory arrest
Gastric changes: acute gastritis, ulceration

Question 29

What are some complications of chronic alcohol abuse?

Answer 29

• Degenerative changes in brain
• Fetal alcohol syndrome
• Liver issues (fatty liver, alcoholic hepatitis, cirrhosis)

Question 30

What are some complications of intravenous drug abuse?

Answer 30

• Brain: overdose, withdrawal
• Pulmonary: narcotic lung, talc granulomas
• Local: abscesses, cellulitis, ulcers, thrombosed veins
• Renal: glomerulopathy
• Infections: bacterial endocarditis, viral hepatitis, AIDS

Question 31

What are some complications of oral contraceptives?

Answer 31

• Vascular: retinal artery thrombosis, stroke, pulmonary embolism, myocardial infarction, hepatic vein thrombosis, mesenteric thrombosis, deep venous thrombosis
• Hepatobiliary: cholestatic jaundice, hepatic adenoma, gallstones

Question 32

What is Reye syndrome?

Answer 32

Acute and potentially life-threatening disorder characterized by fatty liver and encephalopathy, most often seen in children
Classic syndrome involves combination of resolving viral illness and salicylate therapy

Question 33

How can you prevent Reye syndrome?

Answer 33

Avoid giving aspirin to children with viral illnesses

Question 34

What is malnutrition?

Answer 34

Inadequate intake of protein/calories or deficiencies in digestion/absorption, leading to loss of fat/muscle mass, weight loss, and weakness

Question 35

What are the two types of malnutrition?

Answer 35

• Primary malnutrition: lack of essential nutrients in the diet
• Secondary malnutrition: results from malabsorption, increased nutrient needs, or loss

Question 36

What are some causes of malnutrition?

Answer 36

• Poverty
• Acute/chronic illness
• Chronic alcoholism
• Ignorance
• Self-imposed dietary restriction
• Other causes: GI diseases, genetic disorders, drug therapies

Question 37

What defines severe acute malnutrition?

Answer 37

A weight-for-height ratio of 3 SD below normal

Question 38

What are the forms of SAM?

Answer 38

• Marasmus: severe calorie deficiency; muscle mass loss, fat utilization
• Kwashiorkor: protein deficiency; edema, hypoalbuminemia, liver enlargement

Question 39

How can you clinically assess SAM?

Answer 39

Body weight comparison, skinfold thickness, serum protein levels

Question 40

What populations in higher income countries most commonly have malnutrition?

Answer 40

Older people in nursing homes

Question 41

What is cachexia?

Answer 41

Associated with AIDS and advanced cancers; marked by weight loss and muscle wasting

Question 42

What is anorexia nervosa?

Answer 42

Self-induced starvation; highest death rate among psychiatric disorders

Question 43

What is bulimia?

Answer 43

Binge eating followed by vomiting; generally better prognosis than anorexia

Question 44

What are clinical features of anorexia?

Answer 44

Amenorrhea, cold intolerance, decreased bone density

Question 45

What are clinical features of bulimia?

Answer 45

Electrolyte imbalances, risks from vomiting/laxative use

Question 46

What is obesity?

Answer 46

An accumulation of adipose tissue that impairs health, measured by body mass index

Question 47

What are health risks of obesity?

Answer 47

• Metabolic syndrome: insulin resistance, hypertension, dyslipidemia
• Chronic diseases: type 2 diabetes, CV disease, nonalcoholic fatty liver disease, various cancers
• Inflammation: elevated inflammatory markers contribute to health complications
• CV risks: hyperinsulinemia and dyslipidemia heighten coronary artery disease risk
• Sleep disorders: obstructive sleep apnea linked to obesity can lead to heart failure
• Joint health: increased body weight contributes to osteoarthritis

Question 48

What are the functions of Vitamin A and what are the associated deficiency syndromes?

Answer 48

• Component of visual pigment: night blindness, xerophthalmia, blindness
• Maintenance of specialized epithelia: squamous metaplasia
• Maintenance of resistance to infection: vulnerability to infection, particularly measles

Question 49

What are the functions of Vitamin D and what are the associated deficiency syndromes?

Answer 49

• Faciliates intestinal absorption of calcium and phosphorus and mineralization of bone
• Rickets in children, osteomalacia in adults

Question 50

What are the functions of Vitamin E and what are the associated deficiency syndromes?

Answer 50

• Major antioxidant; scavenges free radicals
• Spinocerebellar degeneration; hemolytic anemia in premature infants

Question 51

What are the functions of Vitamin K and what is the associated deficiency syndrome?

Answer 51

• Cofactor in hepatic carboxylation of procoagulants - factors II, VII, IX, and X, protein C and protein S
• Bleeding diathesis