environmental disease quick hits

Question 1

2 conditions where you see basophillic stippling

Answer 1

lead poinsoing

megaloblastic anemia: Vitamin B12 deficiency and folate deficiency

Question 2

Cognitive impairment (especially memory), behavior problems (especially hyperactivity), decreased verbal ability, hearing loss, irritability, lethargy, fatigue, myalgia, vomiting and anemia

Answer 2

What are the manifestations of lead toxicity in children at low concentrations?

Question 3

Colicky abdominal pain, arthralgia, renal insufficiency, constipation, tremor, headache, intellectual disability, seizures, coma and death

Answer 3

What are the manifestations of lead toxicity in children at higher concentrations?

Question 4

Short-term memory loss, difficulty concentrating, anxiety, phobias, irritability, depression and hostility

Answer 4

What are the manifestations of lead toxicity in adults at low concentrations?

Question 5

Peripheral demyelinating neuropathy (especially motor, especially of hands, then feet), myalgia, arthralgia, diffuse severe abdominal pain (lead colic), constipation, renal insufficiency, anemia, headache, anorexia and decreased libido

Answer 5

What are the manifestations of lead toxicity in adults at higher concentrations?

Question 6

what is the pathophys of lead toxicity?

which enzyme does lead inhibit –> increased free protoporphyrin?

which enzymes does lead inhibit –> basophillic stippling?

Answer 6

Lead is an electropositive metal with high affinity for negatively charged sulfhydryl groups leading to the inhibition of sulfhydryl dependent enzymes like delta-aminolevulinic acid dehydratase (δ-ALA-D) and ferro-chelatase in heme synthesis, leading to high free erythrocyte protoporphyrins.

Inhibition of pyrimidine 5’ nucleotidase can cause degradation of **ribosomal RNA in red cells, leading to basophilic stippling. **

Question 7

how does lead –> neurotox?

Answer 7

interferes w/Ca2+ dependent processes

activation of protein kinase C

Divalent competion w/Ca2+ –> neuro tox

Question 8

how do you distinguish lead tox from iron def?

Answer 8

Both are hypochromic and microcytic, but

lead toxicity is associated with basophilic

** stippling** of red cells and high red cell free

** protoporphyrin (or zinc protoporphyrin)**

Question 9

how do toxins in cigarrette smoke contribute to atherosclerosis? (5 ways here)

Answer 9

Toxins in cigarette smoke get into

the bloodstream and

1. injure endothelial cells, increasingpermeability of lipids into arteries
2. induce a procoagulant state
3. increase heart rate, blood pressureand myocardial contractility, whichincreases heart need for blood
4. decrease blood oxygen-carryingcapacity (carbon monoxide)
5. play a role in causing one-thirdof myocardial infarctions

Question 10

which component of cigarretes causes the most cardiovascular harm

Answer 10

Nicotine is the component of cigarette

smoke that causes most of the

cardiovascular harm of smoking, so

Electronic cigarettes have most of

the cardiovascular harm of

tobacco cigarettes.