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Pathology > Environmental and Nutritional Pathology > Flashcards

Environmental and Nutritional Pathology Flashcards

1
Q

What is the difference between phase I and phase II reactions?

A

Phase I:

  • Oxidation/ Reduction reactions
  • Hydrolysis
  • Ex: monooxygenase systems, peroxidase-dependent cooxidation

Phase II:

  • Conjugations/ Additions
    • Glucuronidation
    • Sulfation
    • Methylation
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2
Q

What enzyme system converts benzo [a] pyrene (found in tobacco smoke) to an epoxide that covalently binds and damages DNA? What phase reaction is this?

A

Cytochrome P-450 dependent monooxygenase system

Phase I

Liver

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3
Q

What enzyme system metabolizes Nicotine and other amides? What phase reaction is this?

A

flavin-containing monooxygenase system

Phase I

Liver

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4
Q

What enzyme system metabolizes naphthylamine to its carcinogenic derivative? (There are two.) What phase reaction?

A
  • Peroxidase- dependent cooxidation
    • Phase I
    • Catalyzed by prostaglandin-H synthase
    • seminal vesicles, kidney, liver
  • P-450 followed by glucuronidation
    • Phase I and II
    • secondary metabolite excreted in urine, carcinogen, causes bladder cancer
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5
Q

What metabolic reaction is used to process inorganic mercury? What is the resulting molecule? What organ systems are affected?

A
  • Biomethylation => methyl mercury
  • Organ systems:
    • uptake by GI
    • crosses BBB (brain damage)
    • crosses placenta
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6
Q

How are drugs metabolized by glutathione conjugation excreted?

A

bile and urine

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7
Q

What carcinogens are present in tobacco and what organs do they affect?

A
  • tar
  • aromatic hydrocarbons
    • cancer of mouth, larynx, lungs
  • N-nitrosonicotine
    • cancer of esophagus
  • 4-aminobiphenyl and 2-naphthylamine
    • bladder cancer
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8
Q

What are the physiological effects of nicotine?

A
  • increased HR and BP
  • increased coronary artery blood flow
  • Increased cardiac outbut (increased O2 demand)
  • Mobilization of FFA
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9
Q

What are the most common diseases associated with smoking?

A
  • Lung Cancer
  • emphysema/ COPD
  • MI
  • Systemic atherosclerosis
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10
Q

What receptors does ethanol act on?

A
  • GABA
  • N-methyl-aspartate
  • Opioid receptors
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11
Q

How is ethanol metabolized?

A
  • enzyme: alcohol dehydrogenase in gastric mucosa
  • end product: acetaldehyde
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12
Q

What are the effects of ethanol on the liver?

A
  • Steatosis
    • Peripheral fat catabolism
    • Lipid synthesis
  • Hepatitis
    • Fever, hepatomegaly, and jaundice
    • Mallory bodies (fat and hyalin accumulation)
  • Cirrhosis
    • Path: Necrosis and fibrosis
    • Symptoms: muscle wasting, ascites, GI bleed
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13
Q

What does the presence of Mallory bodies in the liver signal?

A

Acute Alcoholic Hepatitis

(fat and hyaline accumulation)

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14
Q

What are the effects of ethanol on the CNS?

A
  • Cause:
    • thiamine (Vit B1) deficiency
  • Path:
    • Neuronal degeneration
    • Cerebellar atrophy
  • Syndromes:
    • Wernike and Korsakoff syndromes
  • Symptoms:
    • Ataxia
    • Ophthalmoplegia
    • Nystagmus
    • Amnesia
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15
Q

What are the effects of ethanol on the CV system?

A
  • Cardiomyopathy
  • HTN
    • From increased release of catecholamines
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16
Q

What are the effects of ethanol on the GI tract?

A
  • Cause
    • impaired absorption of nutrients
  • Result:
    • Gastritis
    • Pancreatitis
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17
Q

What are the effects of ethanol on skeletal muscle?

A
  • Rhabdomyolysis from a breakdown of myoglobin
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18
Q

What are the effects of ethanol on the reproductive system?

A
  • Testicular atrophy
  • Decreased fertility
  • Spontaneous abortion
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19
Q

What types of cancer are caused by ethanol?

A
  • Oral cavity
  • Pharynx
  • Esophagus
  • Breast
  • Liver
    • esp. in combination with HBV/ HCV
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20
Q

What are the symptoms of Fetal Alcohol Syndrome?

A
  • Growth and mental retardation
  • microcephaly
  • facial dysmorphology
  • malformation of brain, heart, GU tract
    • atrial septal defects
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21
Q

What are the metabolites of Methanol? What are the side effects of ingestion?

A
  • Metabolites:
    • Formaldehyde
    • Formic Acid
  • SE
    • Metabolic acidosis
    • Vomiting
    • Blurred vision
    • Respiratory distress
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22
Q

What is the treatment for Methanol poisoning?

A

Ethanol

(competes with alcohol dehydrogenase)

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23
Q

What are the metabolites of Ethylene Glycol? What are the side effects of ingestion?

A
  • Metabolites
    • Glyceraldehyde
    • Oxalic acid
  • SE
    • Vomiting
    • Seizure
    • Renal tubular necrosis
      • accumulation of oxalate crystals
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24
Q

What is the treatment for ethylene glycol poisoning?

A

Ethanol

(competes for aldehyde dehydrogenase)

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25
Q

What are the symptoms of Heroin overdose?

A

Opioid receptor binding

  • Convulsions
  • Cardiorespiratory arrest
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26
Q

What infections are associated with IV drug use?

A
  • HIV
  • Hepatitis
    • HBV, HCV, HDV
  • Endocarditis
    • S. aureus
  • Lung infection
    • M. tuberculosis
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27
Q

What drug can cause perforation of the nasal septum?

A

Cocaine

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28
Q

What are the effects of cocaine on the CV system?

A
  • Increased catecholamines
    • arrhythmias
    • infarction
    • hemorrhage
  • Enhanced platelet activation
    • atherosclerosis
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29
Q

What is the effect of amphetamine on the CV system?

A

ischemic myocardial necrosis

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30
Q

What are the symptoms of amphetamine overdose?

A
  • Delirium
  • Convulsions
  • Arrhythmias
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31
Q

What are the effects of Ecstasy use?

A
  • Panic disorder
  • Hyperthermia
  • DIC
  • Rhabdomyolysis
  • Renal failure
  • Liver failure
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32
Q

What are the acute effects of Cannabinoids?

A
  • Impaired memory
  • Incoordination
  • Euphoria
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33
Q

What are the beneficial effects of THC?

A
  • Decreases intraocular pressure in glaucoma
  • Relieves nausea from chemo
  • Relieves chronic pain
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34
Q

What are the adverse effects of anabolic-androgenic steroids in men?

A
  • Testicular atrophy
  • Gynecomastia
    • excess androgens converted to estradiol
  • HTN
  • Edema
  • Sleep disorders
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35
Q

What are the adverse effects of anabolic-androgenic steroids in women?

A
  • Decreased breast size
  • HTN
  • Edema
  • Sleep disorders
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36
Q

What are the CV effects of anabolic-androgenic steroids?

A
  • HTN
  • Cardiac hypertrophy
  • Sudden death from cardiac arrest
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37
Q

What risks are associated with use of oral contraceptives?

A
  • Cervical cancer
    • in women with HPV
  • Venous thrombosis and Pulmonary Embolism
    • in women deficient in proteins S and C or antithrombin
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38
Q

Which drugs cause erythema multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis?

A
  • Sulfonamides
  • AEDs
  • NSAIDs
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39
Q

What is the difference between erythema multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis?

A
  • erythema multiforme
    • rash localized to skin
    • Target “bull’s eye” lesions
  • Stevens Johnson syndrome
    • rash on skin and mucous membranes
    • up to 10% epidermal loss
  • toxic epidermal necrolysis
    • epidermal loss >30%
    • viscera involvement
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40
Q

What is the most serious respiratory reaction associated with NSAIDs? What causes it?

A

Asthma

  • Cause:
    • inhibition of COX stimulates lipoxygenase pathway
    • Leukotriene overproduction
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41
Q

What are the effects of aspirin overdose?

A
  • Acute
    • Tinnitis
    • Tachypnea
  • Severe
    • Delirium
    • Seizures
    • Pulmonary edema
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42
Q

What are the symptoms of Acetaminophen toxicity?

A
  • Hepatotoxicity
    • elevated aminotransferases and billirubin
  • Liver failure
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43
Q

What is the primary target of outdoor air pollutants?

A

the lungs

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44
Q

What size particulates penetrate the lung and cause symptoms?

A

10 um or less

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45
Q

What are they symptoms of asbestosis? Where are abestos commonly found?

A
  • Signs and Symptoms
    • cough
    • exertional dyspnea
    • Asbestos bodies: fibers coated with iron containing proteins
  • Abestos is common in insulation of old buildings
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46
Q

What are the symptoms of pneumoconiosis? What is the cause?

A
  • aka Black lung disease
  • Signs and symptoms:
    • Cough
    • Exertional dyspnea
    • anthracosis and fibrosis
  • Cause:
    • ​inhaled organic or mineral dust
    • coal workers
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47
Q

What are the signs and symptoms of silicosis?

A
  • Signs and symptoms:
    • Cough
    • Exertional dyspnea
    • Pulm infiltrates
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48
Q

What are the signs and symptoms of beryllium disease?

A
  • Signs and symptoms:
    • Cough
    • Exertional dyspnea
    • Pulm infiltrates
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49
Q

What is the predominant symptoms associated with inhalation of petroleum products?

A

headache

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50
Q

What is the most toxic aromatic hydrocarbon? What are the side effects resulting from exposure?

A
  • Benzene
  • SE
    • aplastic anemia
    • acute leukemia
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51
Q

What are the effects of exposure to benzo[a]pyrene?

A
  • Short term
    • anemia
    • immunosuppression
  • Long term
    • lung, bladder, skin cancers
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52
Q

Exposure to what chemical causes increased risk for angiosarcoma of the liver?

A

Vinyl chloride

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53
Q

What are the effects of vinyl chloride exposure? What is the metabolite that causes these effects?

A
  • Metabolite
    • chloroacetaldehyde
  • Effects
    • destabilizes DNA (carcinogen)
    • Angiosarcoma of the liver
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54
Q

What are the effects of Elemental mercury exposure?

A
  • hemoptysis
  • chest pain
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55
Q

What are the effects of oxidized elemental mercury exposure?

A
  • CNS manifestations
  • Nephrotic syndrome
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56
Q

What are the effects of inorganic mercury exposure?

A

Occurs from ingestion

  • GI symptoms
  • Renal (nephrotic syndrome)
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57
Q

What are the effects of methylmercury exposure?

A

from eating fish

  • sensorimotor syptoms
    • parasthesias
    • paralysis
    • vision or hearing loss
58
Q

Who is most susceptible to lead poisoning? Why?

A

Children and infants

Taken up by developing bones and teeth

59
Q

What are the effects of lead toxicity?

A
60
Q

What are the effects of lead toxicity?

A
  • Blood
    • Microcytic hypochromic anemia
  • CNS
    • inhibits nerve transmission and brain development
  • Other
    • Renal damage
    • Interferes with vit D metabolism
61
Q

Why does lead poisoning cause microcytic hypochroic anemia?

A

it inhibits incorporation of iron into heme

62
Q

What are the effects of Cobalt toxicity?

A
  • Peripheral neuropathy
  • Renal tubular necrosis with proteinuria
  • Lung fibrosis
63
Q

Chromium exposure is associated with an increased risk of what type of cancer?

A

Lung cancer

64
Q

What are the effects of Nickel toxicity?

A
  • Contact dermatitis
  • increased risk of lung cancer
65
Q

What are the effects of organochlorine exposure?

A

low toxicity for humans

High exposure causes immunosuppression

66
Q

What are the effects of organophosphates?

A

AChE inhibitors (anti-muscarinic actions)

Abnormal nerve transmission

67
Q

What are the effects of carbamate exposure?

A
  • AChE inhibitor
  • teratogen
68
Q

What are the effects of exposure to botanicals?

A
  • paresthesias
  • pulmonary irritation
  • contact dermatitis

(insecticide)

69
Q

What are the effects of herbicide exposure?

A

cancer

70
Q

What are the effects of fungicide exposure?

A

reproductive toxicity

71
Q

What are the effects of ergot alkaloid exposure?

A
  • Gangrenous form of ergotism
  • Convulsive ergotism
72
Q

What are the effects of aflatoxin exposure?

A
  • Target: liver
    • hepatitis
    • hepatocellular carcinoma
73
Q

What is the cause of scombroid fish poisoning? What reaction results?

A
  • Cause
    • improperly stored fish (above 20C for a few hours)
  • Reaction
    • resembles IgE-mediated rxn
      • flushing, rash, tachycardia
74
Q

What is the cause of Ciguatera fish poisoning? What symptoms result?

A
  • Cause:
    • ciguatoxin
    • comsumption of contaminated reef fish
      • Carribean
  • Symptoms
    • Acute gastroenteritis
    • Neuro
      • paresthesia
      • blurred vision
      • hot/cold temp reversal
    • CV
      • arrhythmia
      • heart block
75
Q

What is the cause of Paralytic shellfish poisoning? What symptoms result?

A
  • Cause:
    • saxitoxins
  • Symptoms:
    • Neurologic
      • face and neck numbness
      • incoordination
      • difficulty breathing
    • Paralysis
    • Respiratory failure
76
Q

What is the cause of Amnesic shellfish poisoning? What symptoms result?

A
  • Cause
    • domoic acid
    • contaminated mussels
  • Symptoms
    • GI symptoms
    • Confusion
    • memory loss
    • disorientation
77
Q

What is the cause of Neurotoxic shellfish poisoning? What symptoms result?

A
  • Cause
    • brevetoxin (neurotoxin)
    • hemolysin
  • Symptoms (ingestion)
    • gastroenteritis
    • face and neck numbness
    • incoordination
  • Symptoms (inhalation)
    • reversible respiratory syndrome
      • rhinorrhea
      • cough
      • bronchoconstriction
78
Q

What are the characteristics of ionizing radiation?

A
  • Characteristics
    • short wavelength
    • high frequency
    • ionize biologic molecules
79
Q

What are two types of particulate radiation and what are their properties?

A
  • alpha particles
    • strong ionizing power
    • large (don’t penetrate well)
  • beta particles
    • weak ionizers
    • greater penetration (small)
80
Q

What is a unit of charge produced by x-rays or gamma rays that ionize a specific volume of air?

A

roentgen

81
Q

What is the dose of radiation that will produce absorption of 100 ergs of energy per gram tissue?

A

rad (radiation absorbed dose)

82
Q

What is the dose of radiation that causes a biologic effect equivalent to 1 rad of x rays or gamma rays?

A

rem (roentgen equivalent in man)

83
Q

What is the dose of radiation that produces the absorption of 1 joule of energy/kg of tissue?

A

Gray (Gy)

1 Gy = 100 rads = 1 J/kg

84
Q

What is the dose of radiation that causes a biologic effect equivalent to 1 gray (Gy)?

A

sievert (Sv)

1 Sv= 100 rem

85
Q

What is the average whole body lethal dose (LD50) of radiation?

A

3.5-5.5 Gy (w/i 3-6 weeks)

86
Q

What is the dose of radiation that leads to 100% death in 2-3 weeks?

A

5.5-7.5 Gy

87
Q

What cells are most susceptible to radiation?

A

Rapidly dividing cells

Cells in G2 and M phases

88
Q

What are the chronic effects of radiation injury?

A
  • Fibrosis
  • Carcinogenesis
89
Q

What form of acute radiation syndrome is associated with doses < 0.5 Gy?

A

Subclinical

  • Symptoms
    • mild nausea and vomiting
    • slight depression of lymphocytes (still normal)
      • <1500
90
Q

What form of acute radiation syndrome is associated with doses 0.5 - 3.5 Gy?

A

Hematopoietic

  • Symptoms
    • intermittant nausea/ vomiting
    • Petechiae
    • hemorrhage
    • lymphocytes <1000
  • May require BM transplant
91
Q

What form of acute radiation syndrome is associated with doses 3.5 - 10 Gy?

A

GI

  • Symptoms:
    • Vomiting and diarrhea
    • hemorrhage and infection
    • lymphocytes <500
    • thrombocytopenia
  • Shock and death result
92
Q

What form of acute radiation syndrome is associated with doses < 10 Gy?

A

Cerebrovascular

  • Symptoms
    • GI
    • Neuro
      • confusion
      • convulsions
    • Lymphocytes absent
  • Rapid death results
93
Q

What are the risks of radiation to fetus less than 9 weeks old?

A

malformations

(critical stages of organogenesis)

94
Q

What are the risks of radiation to fetus more than 9 weeks old?

A

CNS abnormalities

Reproductive abnormalities

95
Q

What are the risks of radiation postnatally?

A

retarded bone growth

CNS developmental delays

96
Q

What disease results from fibrosis of the kidneys from radiation damage?

A

HTN

97
Q

What can result from radiation exposure of the eye?

A

cataracts

98
Q

What can result from radiation exposure of the spinal cord?

A

Transverse myelitis

  • demyelination leading to paraplegia
99
Q

What results from intense UVA and UVB exposure?

A
  • Mast cell degranulation and release of cytokines
    • erythema
  • Increased pigmentation
  • injury to Langerhans cells and keratinocytes
  • Damage to collagen and elastin
    • Premature aging
100
Q

What is the UV response pathway?

A
  • Activation of proto-oncogenes associated with cell proliferation
  • Result: Cancer
    • no DNA damage
101
Q

How much blood must be lost for shock to occur?

A

1/3 of blood volume

102
Q

Full-thickness Burns

  • Extent of damage to skin
  • Treatment
A
  • Total destruction of epidermis and dermis
    • loss of dermal appendages that would have provided cells for epithelial regeneration
  • Treatment:
    • skin grafting
103
Q

What is the main concern when more than 20% of the body surface has been burned?

A

Hypovolemic shock

104
Q

What is the main concern when over 40% of the body surface has been burned?

A

Hypermetabolic state

  • Increased heat loss
  • Need parenteral nutrition
105
Q

What is the difference between hyperthermia and heat stroke?

A
  • Hyperthermia
    • core temp above 37.5C
    • Loss of electrolytes causes heat cramps and exhaustion
  • Heat stroke
    • core temp above 40.5C (105F)
    • Peripheral vasodilation and pooling of blood
    • Arrhythmias and rhabdomyolysis may occur
106
Q

Lichtenberg figures are pathognomonic for what?

A

Lightning strike injuries

(feathering skin injury)

107
Q

Caisson disease of the bone is caused by what?

A

Decompression disease

  • Focal area of necrosis from embolic occlusion of the vascular supply
108
Q

What are the symptoms of decompression disease?

A

aka Caisson disease

  • muscle and joint pain
  • respiratory difficulties
  • CNS problems (vision, headache)
109
Q

Patient presents with a 60% reduction in normal body weight with a significant loss of muscle mass and body fat. Serum albumin levels are near normal. What is the disease? What is the cause?

A

Marasmus

  • Severe reduction in caloric intake
110
Q

Patient presents with growth retardation, skin lesions (hypo and hyperpigmentation), edema, enlarged fatty liver, and hypoalbuminemia. What is the disease? What is the cause?

A

Kwashiorkor

  • Caloric intake normal but proteins are absent from diet
  • utilize visceral protein stores (ex: liver)
111
Q

What are the major clinical findings in anorexia?

A

endocrine abnormalities

  • decreased GnRH
    • Amenorrhea
  • decreased TH
    • ​Cold intolerance
    • bradycardia
112
Q

What are the functions of Vit A?

A
  • vision (night vision)
    • rhodopsin in rods
  • differentiation of mucous- secreting epithelium
    • retinoic acid
113
Q

What are the consequences of Vit A deficiency?

A

Night blindness and below

114
Q

What are the functions of Vit D?

A
  • maintain Ca and P levels
    • intestinal absorption
  • Mineralization of bone
115
Q

What are the consequences of Vit D deficiency?

A

Rickets/ Osteomalacia

normal Ca lvls, decreased P lvls

116
Q

What is the function of Vit E?

A
  • Antioxidant
  • Terminates lipid peroxidation
117
Q

What are the consequences of Vit E deficiency?

A
  • Degeneration of posterior columns of spinal cord
    • loss of reflexes
    • ataxia
    • weakness
  • Loss of cells in dorsal root ganglia
    • loss of pain sensation
118
Q

What is the function of Vit K?

A
  • production of clotting factors
    • VII, IX, X, prothrombin
  • activation of proteins C and S (anti- coag)
  • Inhibit osteoclasts
    • promote bone calcification
119
Q

How does Vit K deficiency occur?

A
  • fat malabsorption syndrome
  • loss of gut bacteria
    • synthesize Vit K
    • broad spectrum antibiotic use
    • neonates don’t have bacteria
  • Liver disease
120
Q

What is the most important function of Thiamine (Vit B1)?

A

Maintains neural membrane integrity

121
Q

If niacin (B3) is deficient in the diet, what else must be deficient in order to manifest symptoms?

A

Tryptophan deficiency

(converted to niacin)

122
Q

What is the function of Pantothenic acid (Vit B5)?

A

Coenzyme A

123
Q

Patient presents with symmetric toe, foot, and wrist drop, muscle weakness, and hyporeflexia. What is the disease? In what vitamin is he deficient?

A

Dry beriberi (polyneuropathy)

Vit B1 (thiamine)

124
Q

Patient presents with absent reflexes, ataxia, muscle weakness, and loss of pain sensation. In what vitamin is he deficient?

A

Vit E

125
Q

Patient presents with bowed legs and a history of increased fractures. Labs show normal blood levels of Ca but decreased levels of P. In what vitamin is he deficient?

A

Vit D

126
Q

Patient presents with impaired vision in reduced light, keratomalacia from a dry conjunctiva, and a history of increased infections. Kidney stones are also present. In what vitamin is he deficient?

A

Vitamin A

127
Q

Patient presents with peripheral edema and mural thrombi. What is the disease? In what vitamin is he deficient?

A

Wet beriberi (CV syndrome)

Vit B1 (thiamine)

128
Q

Patient presents with cracks and fissues at the angles of the mough, a magenta tongue, corneal ulcerations and a scaling dermatitis of the face. In what vitamin is he deficient?

A

Vit B2 (Riboflavin)

Cheilosis

Glossitis

Keratitis

129
Q

Patient presents with ophthalmoplegia, nystagmus, confusion, and amnesia. What disease is this? In what vitamin is he deficient?

A

Wernicke Korsakoff syndrome

Vit B1 (Thiamine)

130
Q

Patient presents with dermatitis, diarrhea, and dementia. What is the disease? In which vitamin is he deficient?

A

Pellagra

Niacin (Vit B3)

131
Q

Patient complains of burning feet from distal paresthesia. In which vitamin is he deficient?

A

Pantothenic acid (Vit B5)

132
Q

Patient presents with increased numbers of purpura, bleeding gums, and bowed legs. What is the disease? In what vitamin is he deficient?

A

Scurvy

Vit C

Abnormal collagen production

133
Q

Deficiency in which vitamins results in megaloblastic anemia?

A

Folate

Vit B12

134
Q

Patient presents with hemorrhagic dermatitis around the mouth and eyes and on the arms. In what mineral is he deficient?

A

Zinc

function: component of DNA and RNA polymerase

135
Q

What is the function of selenium? What are the symptoms of deficiency?`

A
  • Function:
    • protects against oxidative damage
    • part of glutathione peroxidase and superoxide dismutase
  • Symptoms:
    • myalgia
    • cardiomyopathy
136
Q

Deficiency of which vitamin results in hypochromic microcytic anemia?

A

Iron

137
Q

Deficiency of which vitamin results in hyperglycemia?

A

Chromium

138
Q

What is the function of leptin?

A

triggers catabolic circuits

reduce food intake and stimulate energy expenditure

139
Q

What is the function of adiponectin?

A

Stimulates FA oxidation

Decreases glucose production (insulin sensitivity)

140
Q

A cancer patient presents with extreme weight loss, fatigue, muscle atrophy, anemia, and anorexia. What is the disease? What agents induce this change?

A

Cachexia

  • Inciting agents:
    • PIF (proteolysis inducing factor)
    • LMF (Lipid mobilizing factor)
    • TNF

Pathology (27 decks)

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